Form N-2 - Individual Housing Account
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F
N-2
STATE OF HAWAII — DEPARTMENT OF TAXATION
O
R
INDIVIDUAL HOUSING ACCOUNT
(REV. 2004)
M
Type or machine print Payer's name
1. TOTAL AMOUNT WITHDRAWN FOR PURCHASE OF FIRST PRINCI-
PAL RESIDENCE AND HELD FOR LESS THAN 365 DAYS IN THE
IHA.
Street Address
2. TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF
__
FIRST PRINCIPAL RESIDENCE AND HELD FOR LESS THAN 365
20
DAYS IN THE IHA.
City, State and ZIP Code
3. TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF
FIRST PRINCIPAL RESIDENCE AND HELD FOR 365 DAYS OR
Federal Employer I.D. No.
MORE IN THE IHA.
Type or machine print Recipient's name (First, Middle, Last)
4. WITHHOLDING. (10% OF LINES 2 & 3 ABOVE)
Street Address
5. TOTAL PAYMENT. (ENTER THE AMOUNT FROM LINE 4 ABOVE.)
City, State and ZIP Code
Copy A
RETURN THIS VOUCHER WITH CHECK OR MONEY ORDER PAYABLE
STATE OF HAWAII
TO THE HAWAII STATE TAX COLLECTOR TO THE HAWAII
Social Security Number
DEPARTMENT OF
DEPARTMENT OF TAXATION, P.O. BOX 1530, HONOLULU, HI
TAXATION
96806-1530.
Form N-2
F
N-2
STATE OF HAWAII — DEPARTMENT OF TAXATION
O
R
INDIVIDUAL HOUSING ACCOUNT
(REV. 2004)
M
Type or machine print Payer's name
1. TOTAL AMOUNT WITHDRAWN FOR PURCHASE OF FIRST PRINCI-
PAL RESIDENCE AND HELD FOR LESS THAN 365 DAYS IN THE
IHA.
Street Address
2. TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF
__
FIRST PRINCIPAL RESIDENCE AND HELD FOR LESS THAN 365
20
DAYS IN THE IHA.
City, State and ZIP Code
3. TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF
FIRST PRINCIPAL RESIDENCE AND HELD FOR 365 DAYS OR
Federal Employer I.D. No.
MORE IN THE IHA.
Type or machine print Recipient's name (First, Middle, Last)
4. WITHHOLDING. (10% OF LINES 2 & 3 ABOVE)
Street Address
5. TOTAL PAYMENT. (ENTER THE AMOUNT FROM LINE 4 ABOVE.)
City, State and ZIP Code
Copy A
RETURN THIS VOUCHER WITH CHECK OR MONEY ORDER PAYABLE
STATE OF HAWAII
TO THE HAWAII STATE TAX COLLECTOR TO THE HAWAII
Social Security Number
DEPARTMENT OF
DEPARTMENT OF TAXATION, P.O. BOX 1530, HONOLULU, HI
TAXATION
96806-1530.
Form N-2
F
N-2
STATE OF HAWAII — DEPARTMENT OF TAXATION
O
R
INDIVIDUAL HOUSING ACCOUNT
(REV. 2004)
M
Type or machine print Payer's name
1. TOTAL AMOUNT WITHDRAWN FOR PURCHASE OF FIRST PRINCI-
PAL RESIDENCE AND HELD FOR LESS THAN 365 DAYS IN THE
IHA.
Street Address
2. TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF
__
FIRST PRINCIPAL RESIDENCE AND HELD FOR LESS THAN 365
20
DAYS IN THE IHA.
City, State and ZIP Code
3. TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF
FIRST PRINCIPAL RESIDENCE AND HELD FOR 365 DAYS OR
Federal Employer I.D. No.
MORE IN THE IHA.
Type or machine print Recipient's name (First, Middle, Last)
4. WITHHOLDING. (10% OF LINES 2 & 3 ABOVE)
Street Address
5. TOTAL PAYMENT. (ENTER THE AMOUNT FROM LINE 4 ABOVE.)
City, State and ZIP Code
Copy A
RETURN THIS VOUCHER WITH CHECK OR MONEY ORDER PAYABLE
STATE OF HAWAII
TO THE HAWAII STATE TAX COLLECTOR TO THE HAWAII
Social Security Number
DEPARTMENT OF
DEPARTMENT OF TAXATION, P.O. BOX 1530, HONOLULU, HI
TAXATION
96806-1530.
Form N-2
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