Form Itps-Coa - Change Of Address Form
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FORM ITPS-COA
03
DO NOT WRITE IN THIS AREA
STATE OF HAWAII
(REV. 2012)
DEPARTMENT OF TAXATION
CHANGE OF ADDRESS FORM
(NOTE: References to “married”, “unmarried”, and “spouse” also means
“in a civil union”, “not in a civil union”, and “civil union partner”, respectively.)
Name
SSN or FEIN
Spouse’s Name
Spouse’s SSN
Contact Phone Number (daytime)
(
)
PLEASE CHANGE MY:
M AILING ADDRESS TO:
BUSINESS ADDRESS (PHYSICAL LOCATION) TO:
c/o or “In care of” (If this is to be deleted, please write “Delete”)
Street (This address cannot be a P.O. Box.)
Street
City, State, Postal/Zip Code
City, State, Postal/Zip Code
Business Phone Number
Residence Phone Number
(
)
(
)
THE CHANGE OF ADDRESS APPLIES TO MY ACCOUNT(S) OR PERMIT AS INDICATED BELOW:
MY NET INCOME ACCOUNT
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY GENERAL EXCISE ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY EMPLOYER’S WITHHOLDING ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY TRANSIENT ACCOMMODATIONS ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY RENTAL MOTOR VEHICLE AND TOUR VEHICLE
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY__________________________________ PERMIT
Permit Number ____________
(Enter the type of permit. For example, liquor, liquid
fuel distributor, liquid fuel retail dealer, cigarette &
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
tobacco (non-retail), or retail tobacco.)
Signature
Title
Date
Spouse’s Signature
Date
— MAILING ADDRESS —
HAWAII DEPARTMENT OF TAXATION
P.O. BOX 259
03
HONOLULU, HI 96809-0259
FORM ITPS-COA
THIS SPACE FOR DATE RECEIVED STAMP
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