Form G-50 - General Excise Branch License Maintenance Form
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1STATE OF HAWAII — DEPARTMENT OF TAXATION
DO NOT WRITE IN THIS AREA
FORM G-50
05
(REV. 2007)
GENERAL EXCISE BRANCH LICENSE
Clear Form
MAINTENANCE FORM
(New, Change, Or Cancel Branch Activity)
TYPE OR PRINT LEGIBLY
1. TAXPAYER’S
W
-
(A) HAWAII TAX I.D. NO.
___ ___ ___ ___ ___ ___ ___ ___
___ ___
(B) NAME
2. BRANCH INFORMATION:
CHECK ONE AND COMPLETE ITEMS INDICATED:
£
1 New (complete all items in (A) below)
£
2 Change (complete only items you are changing in (A) below)
£
3 Cancel (complete all items in (B) below)
(A) New or Change
(1) Branch DBA Name
(2) Branch Business Location Address
(3) Branch Business City/State
Zip Code
(4) Branch NAICS Code __ __ __ __ __ __
(5) Date Branch Business Started
/
/
MO
DAY
YR
(B) Cancel (Attach certificate of Branch to be cancelled)
(1) Branch DBA Name
(2) Branch Business Location Address
(3) Branch Business City/State
Zip Code
(4) Date Branch Business Cancelled
/
/
MO
DAY
YR
MAILING ADDRESS & TELEPHONE NUMBERS
HAWAII DEPARTMENT OF TAXATION
P.O. Box 1425
Honolulu, HI 96806-1425
Telephone: 808-587-4242
Toll Free: 1-800-222-3229
THIS SPACE FOR DATE RECEIVED STAMP
The above information is hereby certified to be correct to the best knowledge and
belief of the undersigned who is duly authorized to sign this form and
understands that an unsigned form will not be accepted.
SIGNATURE
DATE
TITLE (OWNER, PARTNER OR MEMBER, OFFICER)
CONTACT PHONE NO. (daytime): ( _____ ) ____________________________
05
FORM G-50
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