Form Ta-12 - Amended - Transient Accommodations Tax Annual Return & Reconciliation - 2008
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FORM TA-12
STATE OF HAWAII — DEPARTMENT OF TAXATION
DO NOT WRITE IN THIS AREA
27
(REV. 2008)
— AMENDED —
TRANSIENT ACCOMMODATIONS TAX
ANNUAL RETURN & RECONCILIATION
FOR CALENDAR YEAR 20 __ __
OR FISCAL YEAR ENDING ____/____/____
(For tax years beginning AFTER December 31, 1998)
NAME:
W_ _ _ _ _ _ _ _ - _ _
HAWAII TAX I.D. NO.
LAST 4 DIGITS OF YOUR FEIN OR SSN: __ __ __ __
THIS FORM SHOULD BE USED ONLY AFTER THE ORIGINAL RETURN HAS BEEN FILED AND WITHIN THREE YEARS
OF THE DUE DATE OR FILING DATE OF THE ORIGINAL ANNUAL RETURN, WHICHEVER IS LATER.
GROSS RENTAL OR
EXEMPTIONS/DEDUCTIONS
TAXABLE PROCEEDS
RATE
TAXES
DISTRICT
GROSS RENTAL PROCEEDS
(EXPLAIN ON REVERSE SIDE)
a
b
c
d
TAXATION DISTRICT 1
1
.0725
1
(OAHU)
2
TAXATION DISTRICT 2
.0725
2
(MAUI, MOLOKAI, LANAI)
3
TAXATION DISTRICT 3
.0725
3
(HAWAII)
4
TAXATION DISTRICT 4
.0725
4
(KAUAI)
5
TOTAL TAXES DUE (ADD LINES 1 through 4 of column d, AND ENTER HERE)
5
6
PENALTY
6
7
INTEREST
7
8
TOTAL AMOUNT DUE (ADD LINES 5, 6, and 7; ENTER AMOUNT HERE.)
8
TOTAL TAXES PAID ON MONTHLY, QUARTERLY, OR SEMIANNUAL RETURNS FOR THE PERIOD AND THE
9
9
9
ANNUAL RETURN, IF APPLICABLE. PART III ON REVERSE SIDE MUST ALSO BE COMPLETED.
10
ADDITIONAL ASSESSMENTS PAID FOR THE PERIOD, IF INCLUDED ABOVE.
10
10
11
PENALTIES $ ______________ INTEREST $ ______________ PAID DURING THE PERIOD.
11
11
12
TOTAL PAYMENTS MADE (ADD LINES 9, 10, and 11)
12
12
13
CREDIT TO BE REFUNDED AS SHOWN ON ORIGINAL ANNUAL RETURN
13
13
14
NET PAYMENTS MADE (LINE 12 MINUS LINE 13)
14
15
IF LINE 14 IS LARGER THAN LINE 8, ENTER CREDIT TO BE REFUNDED (LINE 14 MINUS LINE 8)
15
16
IF LINE 8 IS LARGER THAN LINE 14, ENTER TAXES DUE (LINE 8 MINUS LINE 14)
16
17a Penalty
FOR LATE FILING ONLY
17
17b Interest
18
TOTAL AMOUNT NOW DUE AND PAYABLE (ADD LINES 16 AND 17)
18
PLEASE ENTER AMOUNT OF YOUR PAYMENT
19
19
(PAY IN U.S. DOLLARS ONLY)
20
GRAND TOTAL EXEMPTIONS/DEDUCTIONS FROM BACK OF FORM
20
ATTACH YOUR CHECK OR MONEY ORDER PAYABLE TO HAWAII STATE TAX COLLECTOR
IN U.S. DOLLARS DRAWN ON ANY U.S. BANK AND FORM VP-1 TO FORM TA-12. WRITE “TA”, THE FILING
PERIOD, AND YOUR HAWAII TAX I.D. NO. ON YOUR CHECK OR MONEY ORDER.
YOU MAY ALSO E-PAY AT
DECLARATION: I declare, under the penalties set forth in section 231-36, HRS, that this return, including any
accompanying schedules or statements, has been examined by me and, to the best of my knowledge and belief, is a
true, correct, and complete return, made in good faith for the taxable period stated, pursuant to the Transient
Accommodations Tax Law, Chapter 237D, HRS and the rules issued thereunder. I also reaffirm my statements on
my operator’s registration (as amended).
A CORPORATION OR PARTNERSHIP TAX RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR
MEMBER, OR DULY AUTHORIZED AGENT OF SUCH ENTITY.
SIGNATURE
TITLE
DATE
(
)
DAYTIME PHONE NUMBER:
—MAILING ADDRESS—
HAWAII DEPARTMENT OF TAXATION
THIS SPACE FOR DATE RECEIVED STAMP
P.O. BOX 2430
27
FORM TA-12
HONOLULU, HI 96804-2430
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