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Form N-288a - Statement Of Withholding On Dispositions By Nonresident Persons Of Hawaii Real Property Interests - 2001 Page 3

2001

DO NOT WRITE OR STAPLE IN THIS SPACE

STATE OF HAWAII — DEPARTMENT OF TAXATION

N-288A

Form

STATEMENT OF WITHHOLDING ON

(Rev. 2000)

DISPOSITIONS BY NONRESIDENT PERSONS OF

HAWAII REAL PROPERTY INTERESTS

Copy C — For Transferee’s/Buyer’s Records.

1. Description and location of property transferred (Include tax map

6. Transferor/Seller is:

key number)

An individual or

A partnership

revocable living trust

A corporation

An S corporation

2. Date of transfer or installment

3. Amount realized

A trust or estate

Other (Specify) ___________________

payment date

(sales or contract price)

7. If the transferor/seller is reporting the gain under the installment

method, check box

•

4. Transferee/Buyer’s identification no.

8. Transferor/Seller’s identification

9. Hawaii income tax withheld

(SSN or FEIN)

no., (SSN or FEIN) (Enter only one

(Whole dollars only)

identification number.)

5. Transferee/Buyer’s name

•

10. Name of transferor/seller (See Instructions before entering name. Enter

only one name, unless husband and wife filing a joint return. If more than

one transferor/seller, use separate form.)

Street address

City, state, and ZIP code

City, province or state, postal code, and country

THIS FORM IS TO BE USED FOR TRANSFERS OR PAYMENTS MADE IN 2001 ONLY.