Form G-49 - General Excise/use Annual Return & Reconciliation Page 2

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FORM G-49
Page 2 of 2
Name:___________________________________________________
Hawaii Tax I.D. No. W
—
Tax Year Ending
/
/
Last 4 digits of your FEIN or SSN ___ ___ ___ ___
GCI082
Column a
Column b
Column c
BUSINESS
VALUES, GROSS PROCEEDS
EXEMPTIONS/DEDUCTIONS
TAXABLE INCOME
ACTIVITIES
OR GROSS INCOME
(Attach Schedule GE)
(Column a minus Column b)
PART III - INSURANCE COMMISSIONS @ .15% (.0015)
!!!,!!!,!!!.00 !!!,!!!,!!!.00 !!!,!!!,!!!.00
Neg
18. Insurance
Commissions
Enter this amount on line 23, Column (a)
PART IV - CITY & COUNTY OF HONOLULU SURCHARGE TAX @ ½ OF 1% (.005)
!!!,!!!,!!!.00 !!!,!!!,!!!.00 !!!,!!!,!!!.00
Neg
19. Oahu Surcharge
Enter this amount on line 24, Column (a)
PART V — SCHEDULE OF ASSIGNMENT OF TAXES BY DISTRICT (ALL taxpayers MUST complete this Part and may
be subject to a 10% penalty for noncompliance.) See Instructions. DARKEN the oval of the taxation district in which you
have conducted business. IF you did business in MORE THAN ONE district, darken the oval “MULTI” and attach Form
=
=
=
=
=
G-75.
20.
Oahu
Maui
Hawaii
Kauai
MULTI
PART VI - TOTAL RETURN AND RECONCILIATION
TAXABLE INCOME
TAX RATE
TOTAL TAX
Column (a)
Column (b)
Column (c) = Column (a) X Column (b)
21.
Enter the amount from Part I, line 7 .......................
$
.00
x .005
= $ ______________________
22.
Enter the amount from Part II, line 17 ....................
$
.00
x
.04
= $ ______________________
23.
Enter the amount from Part III line 18, Column c ...
$
.00
x .0015
= $ ______________________
24.
Enter the amount from Part IV, line 19, Column c ..
$
.00
x .005
= $ ______________________
TOTAL TAXES DUE.
!!!,!!!,!!!.!!
25.
Add column (c) of lines 21 through 24 and enter result here. If you
Neg
did not have any activity for the period, enter “0.00” here ......................................................... 25.
PENALTY $
26. Amounts Assessed on Periodic Returns...................
26.
INTEREST $
!!!,!!!,!!!.!!
TOTAL AMOUNT.
27.
Add lines 25 and 26. ................................................................................... 27.
!!!,!!!,!!!.!!
28. TOTAL PAYMENTS MADE LESS ANY REFUNDS RECEIVED FOR THE TAX YEAR ................... 28.
!!!,!!!,!!!.!!
29. CREDIT CLAIMED ON ORIGINAL ANNUAL RETURN. (For Amended Return ONLY) ................... 29.
!!!,!!!,!!!.!!
30. NET PAYMENTS MADE. Line 28 minus line 29 .............................................................................. 30.
!!!,!!!,!!!.!!
31. CREDIT TO BE REFUNDED. Line 30 minus line 27 ....................................................................... 31.
!!!,!!!,!!!.!!
32. ADDITIONAL TAXES DUE. Line 27 minus line 30 .......................................................................... 32.
PENALTY $
FOR LATE FILING ONLY 
33.
INTEREST $
33.
!!!,!!!,!!!.!!
34. TOTAL AMOUNT DUE AND PAYABLE (Add lines 32 and 33) ........................................................34.
AMOUNT OF YOUR PAYMENT
. Attach a check or money order payable
35. PLEASE ENTER THE
to “HAWAII STATE TAX COLLECTOR” in U.S. dollars to Form G-49. Write “GE”, the filing period, and your Hawaii Tax
I.D. No. on your check or money order. Mail to: HAWAII DEPARTMENT OF TAXATION, P. O. BOX 1425,
!!!,!!!,!!!.!!
HONOLULU, HI 96806-1425 or file and pay electronically at
If you are NOT submitting a payment with this return, please enter “0.00” here. ................... 35.
GRAND TOTAL OF EXEMPTIONS/DEDUCTIONS CLAIMED.
36.
!!!,!!!,!!!.00
(Attach Schedule GE) If Schedule GE is not attached, exemptions/deductions
claimed will be disallowed. .......................................................................................... 36.
Form G-49
16
(Rev. 2008)

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