Form N-288c - Application For Tentative Refund Of Withholding On Dispositions By Nonresident Persons Of Hawaii - 2013

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FORM

STATE OF HAWAII—DEPARTMENT OF TAXATION

THIS SPACE FOR DATE RECEIVED STAMP

N-288C

Clear Form

APPLICATION FOR TENTATIVE REFUND OF WITHHOLDING

ON DISPOSITIONS BY NONRESIDENT PERSONS OF HAWAII

(REV. 2012)

REAL PROPERTY INTERESTS

2013

For calendar year

or other tax year beginning 

, 2013

NCF121

and ending 

, 20

(NOTE: References to “married”, “unmarried”, and “spouse” also means “in a civil union”, “not in a civil union”, and “civil union partner”, respectively.)

NOTE: DO NOT file this form unless you have received notification from the Department of Taxation that

we have received your withholding payment.



Name (If joint return, give first names and initials of both)

Last Name

Your Social Security Number



Name (Corporation, Partnership, Trust, or Estate)

Spouse’s Social Security Number



Dba or C/O

Federal Employer I.D. No.



Address (number and street)



City, State, and Postal/ZIP Code (province, postal code, and country)



Check only ONE box:

Description of Hawaii real property transaction:



a. Date of transfer (month, day, year) _________________________________

Individual



b. Location and general description of property

Others (Corporation, Partnership,

Trust, or Estate)

c. Tax map key number _____________________________________________



Was the property used at anytime as a rental? Yes

If yes, enter your Hawaii Tax I.D. Number: W __ __ __ __ __ __ __ __ - __ __ and

indicate the start date and end date of the rental activity: (month, day, year) ____________________ to (month, day, year) ____________________

•

1. Enter the amount withheld on Form N-288A. (Attach a copy of Form N-288A) ...............................................................

2. Sales price .......................................................................................................................

3. Cost or other basis (see Instructions) ..............................................................................

4. Gain. Line 2 minus line 3 (see Instructions for installment sales) ....................................

•

5. Enter the tentative tax on the gain (see Instructions) .......................................................................................................

•

6. REFUND of amount withheld. Line 1 minus line 5. (This line MUST be filled in.) ........................................................

I hereby declare under penalties provided by section 231-36, HRS, that I have examined this application and accompanying attachments, and, to the best of my knowledge and

Please

belief, they are true, correct, and complete.



Sign

__________________________________

_________________________

__________________

Signature

Title (If applicable)

Date

Here

