Form Gew-Ta-Rv-5 - General Excise/use, Employer'S Withholding, Transient Accommodations And Rental Motor Vehicle And Tour Vehicle Surcharge Application Changes Page 2

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FORM GEW-TA-RV-5
PAGE 2
(REV. 2009)
15. List the social security number (SSN), name, title, address, city, state, and postal/zip code of each partner, member, or corporate
officer to be ADDED. If the partner or member is not an individual, list the partner’s or member’s federal employer identification
number (FEIN). If more space is needed, attach a separate schedule.
SSN/FEIN
Name
Title
Address
16. List by island, the address of each rental real property, rental motor vehicle and/or tour vehicle (RVST) business, and transient ac-
commodation (TA) to be ADDED. If you are adding a TA or RVST address, place a check mark in the appropriate column below. If
more space is needed, attach a separate schedule.
Check if
Check if
Address
Island
TA
RVST
17. List the social security number (SSN), name, title, and address of each partner, member, or corporate officer to be DELETED. If
the partner or member is not an individual, list the partner’s or member’s federal employer identification number (FEIN). If more
space is needed, attach a separate schedule.
SSN/FEIN
Name
Title
Address
18. List by island, the address of each rental real property, rental motor vehicle and/or tour vehicle (RVST) business, and transient
accommodation (TA) to be DELETED. If you are deleting a TA or RVST address, place a check mark in the appropriate column
below. If more space is needed, attach a separate schedule.
Check if
Check if
Address
Island
TA
RVST
03
FORM GEW-TA-RV-5

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