Form A-9 - Request For A High Tech Comfort Ruling

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FORM A-9

STATE OF HAWAII — DEPARTMENT OF TAXATION

(REV. 2006)

REQUEST FOR A HIGH TECH COMFORT RULING

Name of company performing qualified research

Address of company

Hawaii Tax I.D. No., if any

Federal Employer I.D. No. or Social Security No.

1. To assist in expediting the comfort ruling, complete Form A-9A, “Is a Company a "Qualified High Technology

Business" (QHTB) for Hawaii Income Tax Incentives?”, and submit it with this request.

2. Fully describe the actual activities the company performs that you consider qualified research.

(Use an additional sheet if more space is needed)

3. Is a representative authorized to request the issuance of a ruling and discuss information in connection with this ruling

on behalf of this company?

Yes

(If “yes”, please attach an executed Form N-848.)

4. Attach a check for $1,000 payable to “Director of Finance”. See Department of Taxation Announcement No. 2005-19.

5. Attach an electronic file of the draft of the desired ruling or determination (see sample ruling letter).

6. Include any other supporting material, brochures, applicable website urls, etc.

DECLARATION

Only an individual having personal knowledge of the facts may sign the declaration below. An authorized representative may not sign the declaration.

If this taxpayer is a corporation, partnership, or trust or estate, the individual signing the declaration on behalf of the taxpayer must be a corporate officer,

general partner or member, or fiduciary, as the case may be.

I declare, under the penalties set forth in section 231-36, HRS, that I have personal knowledge of the facts involved in this

request and that I have examined this request, including accompanying documents, and, to the best of my knowledge and

belief, the facts presented in support of this request are true, correct and complete.

Signature

Date

Print or type name

Print or type title

FORM A-9