Form N-4 - Statement Of Withholding For A Nonresident Shareholder Of An S Corporation Page 6

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This form is used to report Hawaii income taxes withheld from a shareholder of an S corporation who is a
nonresident of Hawaii and who has not provided the S corporation with a signed agreement (Schedule NS) to
file a return, make timely payment of all Hawaii taxes imposed with respect to the shareholder’s share of the S
corporation’s Hawaii income, and to be subject to personal jurisdiction in Hawaii for purposes of the collection
of unpaid income tax and related interest and penalties.
Box 3 — Amount of Hawaii Tax Withheld —
Include the amount shown in this box on Form N-15, line 54.
Do not attach this copy of Form N-4 to your Hawaii income tax return. This copy is for your records.
This form is used to report Hawaii income taxes withheld from a shareholder of an S corporation who is a
nonresident of Hawaii and who has not provided the S corporation with a signed agreement (Schedule NS) to
file a return, make timely payment of all Hawaii taxes imposed with respect to the shareholder’s share of the S
corporation’s Hawaii income, and to be subject to personal jurisdiction in Hawaii for purposes of the collection
of unpaid income tax and related interest and penalties.
Box 3 — Amount of Hawaii Tax Withheld —
Include the amount shown in this box on Form N-15, line 54.
Do not attach this copy of Form N-4 to your Hawaii income tax return. This copy is for your records.

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