Form G-71 - General Excise Sublease Deduction Certificate

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FORM G-71

STATE OF HAWAII — DEPARTMENT OF TAXATION

(REV. 2007)

GENERAL EXCISE SUBLEASE DEDUCTION

CERTIFICATE

(Required for lessee’s files)

PART I

Information About the Lessor

Name

Address

City

State

ZIP Code

W __ __ __ __ __ __ __ __ - __ __

Hawaii Tax I.D. Number:

Name of agent (if applicable):

PART II Information About the Lessee

Name

W __ __ __ __ __ __ __ __ - __ __

Hawaii Tax I.D. Number:

PART III Real Property or Space Leased

Description of real property or space leased. Check the appropriate box(es):

vacant land;

apartment, hotel, or

similar residential property;

store, office, or other commercial property;

mining, manufacturing, or other

industrial property;

farm or ranch; or

other (please describe)

Address of real property or space leased

Effective date of the lease

Term of the lease

CERTIFICATION BY LESSOR

(The absence of this certification by the lessor shall give rise to the presumption that the lessee is not allowed the sublease deduction.)

The undersigned lessor hereby certifies, pursuant to section 237-16.5, Hawaii Revised Statutes, that the lessor is subject to the general excise tax on the gross

proceeds or gross income received from the lessee.

Signature of Lessor or Authorized Agent

Title

Date

COPY FOR LESSOR AND LESSEE

FORM G-71