FORM N-346A
TAX YEAR
2015
(REV. 2015)
PAGE 2
STATE OF HAWAII - DEPARTMENT OF TAXATION
CERTIFIED STATEMENT OF RESEARCH AND DEVELOPMENT COSTS
INCURRED BY A QUALIFIED HIGH TECHNOLOGY BUSINESS (QHTB)
AND CLAIM OF THE TAX CREDIT FOR RESEARCH ACTIVITIES
Or fiscal year beginning _________________, 2015, and ending __________________, 20___
Name of taxpayer claiming the credit as shown on Form N-11, N-15, N-20, N-30, N-35, N-40, N-70NP
SSN or FEIN
Part II of Form N-346A is for the Department of Taxation’s use. Upon completion, the Department of Taxation will mail Part II to the QHTB at the address
reported on the face of Form N-346A.
The taxpayer claiming the credit shall attach the completed Part II of Form N-346A to Form N-346, Tax Credit for Research Activities.
Part II
CERTIFICATION -
LINES 1 AND 2 ARE TO BE COMPLETED BY THE TAXPAYER CLAIMING THE CREDIT AND SIGNED BY THE DEPARTMENT OF TAXATION.
Based upon the representations and declarations made by the named QHTB, the Department of Taxation certifies the receipt of the
following information:
1
Amount of eligible research expenses attributable to the research activity conducted
1
IN HAWAII for the 2015 tax year as reported by the named QHTB (see Instructions) . . . . . . . . . . .
2
2
Amount of credit for the 2015 tax year as reported by the named QHTB (see Instructions) . . . . . .
IMPORTANT AUDIT NOTICE: All claims of credit are subject to audit. This certification is based solely on information
provided by the taxpayer and solely acknowledges receipt of such information by the Department. Nothing in this
certification shall be deemed to be an acknowledgment or admission by the Department that the taxpayer is entitled to the
credit claimed. The Department expressly reserves all rights to challenge, in whole or in part, the claim for credit.
Signature of Certifying Officer
Date of Certification
Print Name
Title
FORM N-346A