Form Gew-Ta-Rv-3 - Application For General Excise, Use, Employer'S Withholding, Transient Accommodations, And Rental Motor Vehicle & Tour Vehicle Identification Number Page 2

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FORM GEW-TA-RV-3 (REV. 1997)

Page 2

10. ACCOUNTING PERIOD:

11. ACCOUNTING METHODS:

Calendar Year (The 12-month period from January 1 to

Cash (Report income in the period when it is actually or

December 31.)

constructively received, either in the form of cash or its equivalent,

or other property.)

Fiscal Year Ending: ___ ___ / ___ ___

(A 12-month period ending the last day of any month other than

Accrual (Report income when you earn it, whether or not you

December. Example: June 30 06/30)

actually receive it.)

12. TYPE OF BUSINESS ACTIVITIES: (Check all that apply. See Instructions for description of each business activity.)

List Your Primary Type of Business Activity: _________________________________________

13. DO YOU QUALIFY FOR A DISABILITY EXEMPTION?

Yes

If yes, Forms N-172 and N-857 must be completed and submitted

before the $2,000 exemption of gross income of any blind, deaf, or totally disabled person and rate of 1/2 of 1% on the remaining gross income can be allowed.

14. If you took over the business from a previous owner, state the owner’s/business’ name, last known address, and General Excise Identification number.

Otherwise, enter “not applicable.”

15. (a) List by island the address(es) of your rental real property (e.g., land, building, apartments, condominiums, or hotels or other transient lodging).

(b) List by island the address(es) of your rental motor vehicle and/or tour vehicle business locations.

(c)

If a transient accommodation (T.A.) or a rental motor vehicle or tour vehicle (R.V.) business location, place a check mark in the appropriate column on

the right.

(d) Attach a separate sheet of paper if more space is required.

Check

Addresses

if T.A.

if R.V.

THE ABOVE STATEMENTS ARE HEREBY CERTIFIED TO BE CORRECT TO THE BEST KNOWLEDGE AND BELIEF OF

THE UNDERSIGNED WHO IS DULY AUTHORIZED TO SIGN THIS APPLICATION.

Signature of Owner, Partner or Member, Officer, or Agent

Title: Owner, Partner or Member, Officer, or Agent

Date

MAILING ADDRESSES & TELEPHONE NUMBERS