Form G-55 - Annual Return & Reconciliation - 2002 Page 2
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1
2FORM G-55
(REV. 2002)
LIST DETAILS CONCERNING “EXEMPTIONS” AND “DEDUCTIONS” CLAIMED.
If claims are not explained here, deductions and/or exemptions will be disallowed and proposed assessments prepared against you. If you are claiming a deduction
for payments to subcontractors, you must indicate the subcontractor’s name and general excise license number. If claiming a deduction for certain leases and
subleases of real property, complete Form G-72 and enter the amount of your sublease deduction below. You must also list the name and general excise tax license
number of the Lessor and the total amount you paid the Lessor.
EXEMPTIONS AND DEDUCTIONS
LINE NO.
AMOUNT
SCHEDULE A — ACTIVITIES UNDER CHAPTER 237, HRS — GENERAL EXCISE TAX LAW
SUBTOTAL — SCHEDULE A
LINE NO.
AMOUNT
SCHEDULE B — ACTIVITIES UNDER CHAPTER 238, HRS — USE TAX LAW
SUBTOTAL — SCHEDULE B
GRAND TOTAL (Transfer to front page, line 33.)
(If more space is needed, please attach your schedule.)
ENTER THE TAXES PAID WITH YOUR PERIODIC RETURNS (MONTHLY, QUARTERLY, OR SEMI-ANNUALLY), AND IN
RESPONSE TO ANY RELATED NOTICES OF DELINQUENCY, FOR THE TAX YEAR REPORTED ON THIS RETURN.
MONTH
AMOUNT
MONTH
AMOUNT
MONTH
AMOUNT
MONTH
AMOUNT
______ $ _______________
______
$ _______________
______ $ ______________
______ $ _______________
______ $ _______________
______
$ _______________
______ $ ______________
______ $ _______________
______ $ _______________
______
$ _______________
______ $ ______________
______ $ _______________
1st QTR $ _______________
2nd QTR $ _______________
3rd QTR $ ______________
4th QTR $ _______________
1st SEMIANNUAL PERIOD $ _________________________
2nd SEMIANNUAL PERIOD $________________________
ANNUAL $_________________________________________
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