Form N-2 - Individual Housing Account Page 7
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7F
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 TOTAL AMOUNT WITHDRAWN FOR PURCHASE OF FIRST PRINCI-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 TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF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 TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF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.
City, State and ZIP Code
Copy D
Social Security Number
For Payer
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 TOTAL AMOUNT WITHDRAWN FOR PURCHASE OF FIRST PRINCI-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 TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF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 TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF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.
City, State and ZIP Code
Copy D
Social Security Number
For Payer
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 TOTAL AMOUNT WITHDRAWN FOR PURCHASE OF FIRST PRINCI-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 TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF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 TOTAL AMOUNT WITHDRAWN FOR OTHER THAN PURCHASE OF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.
City, State and ZIP Code
Copy D
Social Security Number
For Payer
Form N-2
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