Fillable Form A-6 - Tax Clearance Application (Page 2 of 2) in pdf

APPLICANT’S NAME FROM PAGE 1

FORM A-6

(REV. 2012)



LIQUOR LICENSING:

Initial

Renewal

Transfer-Seller

Transfer-Buyer

Special Event



CONTRACTOR LICENSING:

Initial

Renewal

STATE RESIDENCY:

DATE APPLICANT ARRIVED OR RETURNED TO HAWAII



10. ACCOUNTING PERIOD:

Calendar year

Fiscal year ending (MM/DD)

11. TAX EXEMPT ORGANIZATION:

A) Provide the Internal Revenue Code Section that applies to your exemption (e.g., 501(c)(3)).



B) Does your organization file federal Form 990-T, Exempt Organization Business Income Tax Return?

YES

C) Is your organization required to file federal Form 990, Return of Organization Exempt From Income Tax, or



federal Form 990-EZ, Short Form Return of Organization Exempt From Income Tax?

YES

If “YES”, your organization is required to obtain a general excise tax license. Go to line 12.

If “NO”, go to line 11D.



D) Does your organization have fundraising income?

YES

If “YES”, your organization is required to obtain a general excise tax license.

12. INDIVIDUAL:

Spouse’s Name

SSN

13. IF YOU DO NOT HAVE A GENERAL EXCISE TAX LICENSE AND REQUIRE A TAX CLEARANCE:

A) Description of your firm’s business



B) Has your firm had any business income in Hawaii?

YES



C) Has your firm had an office, inventory, property, employees, or other representatives in the State of Hawaii?

YES



D) Has your firm provided any services within the State of Hawaii (e.g., servicing computers, training sessions, etc.)?

YES

Note: If you answer “Yes” to any of the above questions, you are required to apply for a general excise tax license.

FILING THE APPLICATION FOR TAX CLEARANCE

The completed application may be mailed, faxed, or submitted in person to the Department of Taxation, Taxpayer Services Branch. Applications which

require an Internal Revenue Service Tax Clearance (liquor licensing) will be forwarded to the Internal Revenue Service after processing is completed by

the Department of Taxation. Allow up to 10 to 15 business days for processing between the Department of Taxation and the Internal Revenue Service.

State Department of Taxation

Internal Revenue Service

TAXPAYER SERVICES BRANCH

WAGE & INVESTMENT DIVISION

P.O. BOX 259

-TC M/S H214

HONOLULU, HI 96809-0259

FIELD ASSISTANCE GROUP 562

TELEPHONE NO.: 808-587-4242

300 ALA MOANA BLVD., #50089

TOLL FREE: 1-800-222-3229

HONOLULU, HI 96850

FAX NO.: 808-587-1488

TELEPHONE NO.: 808-566-2748

FAX NO.: 808-524-5950

830 PUNCHBOWL STREET, RM 124

HONOLULU, HI

96813-5094

TAXPAYER ASSISTANCE CENTER

HONOLULU:

300 ALA MOANA BLVD., RM 1-128

Applications are available at Department of Taxation and IRS offices in Hawaii, and may also be requested by calling the Department of Taxation on Oahu

at 808-587-4242 or toll-free at 1-800-222-3229. The Tax Clearance Application, Form A-6, can be downloaded from the Department of Taxation’s website

( ).

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Clerk’s

TYPE OF TAX

TAX RETURNS FILED STATUS

ITEMS RECEIVED

Initials

INCOME

GENERAL EXCISE/USE/

COUNTY SURCHARGE TAX

HAWAII WITHHOLDING

TRANSIENT ACCOMMODATIONS

RENTAL MOTOR/TOUR VEHICLE

UNEMPLOYMENT INSURANCE