Form D-37 - Notice Of Mortgage, Pledge, Or Purchase

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STATE OF HAWAII — DEPARTMENT OF TAXATION

FORM D-37

(Rev. 2003)

NOTICE OF MORTGAGE, PLEDGE, OR PURCHASE

In accordance with section 231-33(e), Hawaii Revised Statutes, notice is hereby given of the following mortgage, pledge, or purchase

made or about to be made between the parties named below:

Name and address of mortgagor, pledgor, or seller:

(Name)

(Firm or Business Name)

(Social Security Number)

(Hawaii General Excise Number/Federal Employer ID Number)

(Mailing Address)

(Business Mailing Address)

(City)

(State)

(Zip Code)

(City)

(State)

(Zip Code)

(Home Phone Number)

(Business Phone Number)

Name and address of mortgagee, pledgee, or purchaser:

(Name)

(Address or place of business)

Kind of transaction (State whether mortgage, pledge, or purchase):

(Attach copy of instrument, if available)

Amount of mortgage, pledge, or purchase price (if determined): $

Date of mortgage, pledge, or purchase (if made):

(If recorded in the Bureau of Conveyances) Document No.:

Description of property: (If additional space is needed, use a separate sheet, or sheets, and attach same to this notice.)

By:

(Mortgagee, Pledgee, or Purchaser)

Type or Print Name:

Phone Number:

Date:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

RECEIVED

Office of the Director of Taxation

Date:

Taxation District:

By:

Title:

Oahu District Office

Maui District Office

Hawaii District Office

Kauai District Office

P. O. Box 259

P. O. Box 1169