Form G-6 - Application For Exemption From General Excise Taxes

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FORM G-6
STATE OF HAWAII — DEPARTMENT OF TAXATION
(REV. 2012)
APPLICATION FOR
EXEMPTION FROM GENERAL EXCISE TAXES
PLEASE READ THE INSTRUCTIONS (FORM G-6A) BEFORE COMPLETING THIS APPLICATION
1. Federal employer identification number
2. General excise Hawaii tax identification number (if any)
W __ __ __ __ __ __ __ __ - __ __
3. Full name of organization (exactly as it appears in your organizing document)
4. Care of (if applicable)
5. Mailing address (number and street), city or town, state, and postal/ZIP code
6. Business address (number and street), city or town, state, and postal/ZIP code
7. Organization’s website
8. Date organization’s Hawaii activity began
9. Primary contact
a. Name and title
b. Telephone number
c. E-mail address
(
)
10. Organization is applying for a GET exemption as an organization described under Hawaii Revised Statutes (check one):
§ 237-23(a)(3)
§ 237-23(a)(4)
§ 237-23(a)(5)
§ 237-23(a)(6)
§ 237-23(a)(7)
11. Organization has received/applied for a federal income tax exemption as an organization described under Internal Revenue Code (check one):
§501(c)(3)
§501(c)(4)
§501(c)(5) Agricultural or horticultural organization
§501(c)(6)
§501(c)(8)
§501(c)(12) Potable water company
Other: ______________________ (specify)
12. The following items MUST be submitted with this completed application: (See instructions for more information.)
A. Twenty Dollars ($20) Registration Fee made payable to “Hawaii State Tax Collector” (check one):
Was paid when the organization obtained its GET license. (Enter your GET Hawaii I.D. number on line 2.)
Is enclosed.
Mail the completed application to:
B. An IRS determination letter granting federal tax exemption (check one):
Hawaii Department of Taxation
Technical Section
Is enclosed.
P. O. Box 259
Was requested on (MM/DD/YY) ____________, but has not been received.
Honolulu, HI 96809-0259
Was not requested or required. (Enclose a statement to explain why.)
C. Statement to Request Retroactive Approval - If you are requesting retroactive approval, see the instructions.
D. Form BB-1 – Submit this form only if the organization does not have a GET license and the organization is or will
be engaging in fundraising or is required to file federal form 990, 990-EZ, or 990-T.
E. Articles of Organization
F. Amendments to articles of organization (if any)
G. Bylaws and amendments – If the organization has not adopted bylaws, enclose a statement to that effect.
DECLARATION
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 belief, they are true, correct, and complete.
Signature of officer or duly authorized agent
Print name/Title
Date
FOR OFFICIAL USE ONLY:
Approved by:
Title:
Date Approve:
Effective Date:
FORM G-6

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