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FORM N-101A

(REV. 2011)

PAGE 2

prescribed due date, you will owe interest. You may also be charged

You may use the worksheet below to determine the amount of your

penalties.

income tax balance due.

7. Penalties.—Late Filing of Return – The penalty for failure to file a

10. How to Claim Credit for Payment Made With This Form.—

return on time is assessed on the tax due at a rate of 5% per month, or

Show the amount paid with this form on Form N-11, N-13, or N-15;

part of a month, up to a maximum of 25%.

line 40, 29, or 56 respectively.

Failure to Pay Tax After Filing Timely Return – The penalty for failure

If you and your spouse file a joint Form N-101A for 2011 but do not

to pay the tax after filing a timely return is 20% of the tax unpaid within

file a joint income tax return for 2011, you may claim the total automatic

60 days of the prescribed due date. The 60-day period is calculated

extension tax payment on your separate return or on your spouse’s

beginning with the prescribed due date even if the prescribed due date

separate return or you may divide it in any agreed amounts. Be sure

falls on a Saturday, Sunday, or legal holiday.

to enter the social security numbers (or ITINs) of both spouses on the

separate Form N-11, N-13, or N-15 return.

8. Interest.—Interest at the rate of 2/3 of 1% per month or part of a

month shall be assessed on unpaid taxes and penalties beginning with

If you and your spouse file separate Forms N-101A for 2011 and you file

the first calendar day after the date prescribed for payment, whether or

a joint income tax return for 2011, enter on Form N-11, N-13, or N-15; line

not that first calendar day falls on a Saturday, Sunday, or legal holiday.

40, 29, or 56 respectively, the sum of the amounts paid on the separate

Forms N-101A. Also enter the social security numbers (or ITINs) of both

How to Complete Form.––Print your name, address, and

spouses in the spaces on Form N-11, N-13, or N-15.

social security number in the space provided. If you are filing a joint

return, print your spouse’s name and social security number in the

Line-by-Line Instructions for Worksheet

space provided. If you have a foreign address, enter the complete

country name in the space provided. If you are an alien and were

Line 1.—Enter the amount of income tax you expect to owe for 2011.

issued an individual taxpayer identification number (ITIN) by the

If you do not expect to owe tax, enter zero (0). Be sure to estimate the

IRS, enter your ITIN. If you applied for an ITIN but the IRS has not

amount correctly. If you underestimate this amount, you may be charged

yet issued the ITIN, write “ITIN Applied For” in the space above the

a penalty as explained earlier under Penalties.

box where you enter your name.

Line 4.—Enter other payments and credits that you expect to show on

Print the date your tax year ends and the amount of your payment.

Form N-11, N-13, or N-15.

Detach the voucher where indicated. Submit only the voucher portion

Line 6.—Round the amount to the nearest dollar. You must pay the

of this form with your payment.

amount shown on line 6. An extension of time to file your income tax return

Make your check or money order payable in U.S. dollars to “Hawaii State

does not extend the time to pay your income tax. Also, any payment made

Tax Collector” and attach it to the front of Form N-101A. Make sure your

with this extension does not exempt you from the penalty assessed for

name and address appear on your check or money order. Please write

underpaying estimated taxes for 2011.

your social security number, daytime phone number, and “2011 Form

N-101A” on it. Do not send cash.

WORKSHEET

1 Total income tax liability on your income tax return

for 2011 (You may estimate this amount) ........................................1

Note: You must enter an amount on line 1.

If you do not expect to owe tax, enter zero (0)

2 Hawaii income tax withheld .............................................................2

3 2011 estimated tax payments (include 2010

overpayment allowed as a credit) ....................................................3

4 Other payments (see Instructions) ..................................................4

5 Total (add lines 2, 3, and 4) .............................................................5

6 Income tax balance due (line 1 minus line 5). (Whole dollars only) ........................6

Form N-101a - Application For Automatic Extension Of Time To File Hawaii Individual Income Tax Return - 2011 Page 2

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