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STATE OF HAWAII — DEPARTMENT OF TAXATION
Real Estate Mortgage Investment Conduit
Income Tax Return
FORM
N-66
2011
For calendar year 2011 or short tax year beginning
, 20
, ending
, 20
See separate Instructions.
(REV. 2011)
A Federal Employer I.D. No.
Name
B Date REMIC started
Number and Street (P. O. Box number if mail is not delivered to street address)
C Enter total assets at end of tax year
City or Town, State, and Postal/ZIP code. If you have a foreign address, see Instructions.
$
D Check applicable boxes:
(1)
Final return
(2)
Name change
(3)
Change in address
(4)
Amended return
E Hawaii Tax I.D. No.
Section I. — Computation of Taxable Income or Net Loss
W __ __ __ __ __ __ __ __ - __ __
Income — excluding amounts from prohibited transactions
00
1
1
Taxable interest ...................................................................................................................................................
00
2
2
Accrued market discount under IRC section 860C(b)(1)(B) ...............................................................................
00
3
3
Capital gain (or loss) (Schedule D) .....................................................................................................................
00
4
4
Ordinary gain (or loss) (attach Schedule D-1) ....................................................................................................
00
5
5
Other income (attach schedule) ..........................................................................................................................
00
6
Total income (or loss) (add lines 1 through 5) ....................................................................................................
6
Deductions — excluding amounts from prohibited transactions
00
7
7
Salaries and wages .............................................................................................................................................
00
8
8
Rent ....................................................................................................................................................................
00
9
9
Amount accrued to regular interest holders in the REMIC that is deductible as interest ....................................
00
10
10
Other interest ......................................................................................................................................................
00
11
11
Taxes ...................................................................................................................................................................
00
12
12
Depreciation from federal Form 4562 .................................................................................................................
00
13
13
Other deductions (attach schedule) ....................................................................................................................
00
14
Total deductions (add lines 7 through 13) ..........................................................................................................
14
00
15
15
Taxable income (or net loss) (line 6 less line 14). Enter here and on Schedule M, column (c) ...........................
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, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Signature
Date
Print or type name
Title
May the Hawaii Department of Taxation discuss this return with the preparer shown below? (See page 2 of the Instructions.)
Yes
No
Note: This designee does not replace the power of attorney form.
Date
Check if
Preparer’s identification number
Preparer’s
self-employed
Signature
Paid
Federal
Type or Print
Preparer’s
E.I. No.
Preparer’s Name
Use Only
Firm’s name (or yours
if self-employed), Address
Phone no.
and Postal/ZIP Code
Form N-66