Form A-6 - Tax Clearance Application (2010)
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STATE OF HAWAII — DEPARTMENT OF TAXATION
FORM A-6
FOR OFFICE USE ONLY
TAX CLEARANCE APPLICATION
(REV. 2010)
BUSINESS START DATE IN HAWAII
PLEASE TYPE OR PRINT CLEARLY
Form A-6 can be filed electronically. See Instructions.
IF APPLICABLE
/
/
1. APPLICANT INFORMATION:
HAWAII RETURNS FILED
(PLEASE PRINT CLEARLY)
IF APPLICABLE
20______ 20______ 20______
Applicant’s Name
________ ________ ________
Address
City/State/Postal/Zip Code
STATE APPROVAL STAMP
(Not valid unless stamped)
DBA/Trade Name
2. TAX IDENTIFICATION NUMBER:
W
HAWAII TAX ID #
-
FEDERAL EMPLOYER ID #
-
(FEIN)
SOCIAL SECURITY # (SSN)
-
-
3. APPLICANT IS A/AN:
(MUST CHECK ONE BOX)
*
IRS APPROVAL STAMP
CORPORATION
S CORPORATION
TAX EXEMPT ORGANIZATION
INDIVIDUAL
PARTNERSHIP
ESTATE
TRUST
LIMITED LIABILITY COMPANY
LIMITED LIABILITY PARTNERSHIP
Single Member LLC disregarded as separate from owner; enter owner’s FEIN/SSN
Subsidiary Corporation; enter parent corporation’s name and FEIN
4. THE TAX CLEARANCE IS REQUIRED FOR:
(MUST CHECK AT LEAST ONE BOX)
*
*
CITY, COUNTY, OR STATE GOVERNMENT CONTRACT IN HAWAII
LIQUOR LICENSE
**
REAL ESTATE LICENSE
CONTRACTOR LICENSE
BULK SALES
FINANCIAL CLOSING
PROGRESS PAYMENT
PERSONAL
CERTIFIED COPY STAMP
HAWAII STATE RESIDENCY
FEDERAL CONTRACT
LOAN
SUBCONTRACT
OTHER
*
IRS APPROVAL STAMP IS ONLY REQUIRED FOR PURPOSES INDICATED BY AN ASTERISK.
**
ATTACH FORM G-8A, REPORT OF BULK SALE OR TRANSFER
5. NO. OF CERTIFIED COPIES REQUESTED:
6. SIGNATURE:
(
)
-
(
)
-
SIGNATURE
DATE
TELEPHONE
FAX
PRINT TITLE: Corporate Officer, General Partner or Member, Individual (Sole Proprietor), Trustee, Executor
PRINT NAME
POWER OF ATTORNEY. If submitted by someone other than a Corporate Officer, General Partner or Member, Individual (Sole Proprietor), Trustee,
or Executor, a power of attorney (State of Hawaii, Department of Taxation, Form N-848) must be submitted with this application. If a Tax Clearance is
required from the Internal Revenue Service, IRS Form 8821, or IRS Form 2848 is also required. Applications submitted without proper authorization
will be sent to the address of record with the taxing authority. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED.
PLEASE TYPE OR PRINT CLEARLY — THE FRONT PAGE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL.
SEE PAGE 2 ON REVERSE & SEPARATE INSTRUCTIONS. Failure to provide required information on page 2 of this application or as required in the
separate instructions to this application will result in a denial of the Tax Clearance request.
(Page 1 of 2)
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