Dual Rate Form Rv-3 - Rental Motor Vehicle And Tour Vehicle Surcharge Tax Annual Return & Reconciliation

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DUAL RATE FORM RV-3
STATE OF HAWAII — DEPARTMENT OF TAXATION
THIS SPACE FOR DATE RECEIVED STAMP
98
(REV. 2012)
RENTAL MOTOR VEHICLE AND TOUR VEHICLE
SURCHARGE TAX ANNUAL
RETURN & RECONCILIATION
Tax Year Ending
__ __ / __ __ / __ __
RFF121
M M
D D
Y Y
Check this box if this is an AMENDED Return
HAWAII TAX I.D. NO. W
_ _ _ _ _ _ _ _ - _ _
NAME:_________________________________________________
LAST 4 DIGITS OF YOUR FEIN OR SSN:
__ __ __ __
COLUMN A2
COLUMN A1
COLUMN B
COLUMN C
Rental Motor Vehicle
Rental Motor Vehicle
TourVehicle SurchargeTax —
TourVehicle SurchargeTax —
Surcharge Tax — Enter the
Surcharge Tax — Enter the
Enter the Number of Tour
Enter the Number of Tour
Number of Rental Motor Vehicle
Number of Rental Motor Vehicle
Vehicles Carrying 8 - 25
Vehicles Carrying 26 or More
Days Prior to July 1, 2012
Days After June 30, 2012
Passengers
Passengers
1 OAHU DISTRICT
1
2 MAUI DISTRICT
2
3 HAWAII DISTRICT
3
4 KAUAI DISTRICT
4
(Add lines 1 through 4
5 TOTALS
5
of Columns A1 through C)
6 RATES
$3
$7.50
$15
$65
6
7 TAXES
(Multiply line 5 by line 6
7
00
00
00
of Columns A1 through C)
8. TOTAL TAXES DUE.
Add line 7, Columns A1 through C and enter result here. If you did not have any
8
activity for the period, enter “0.00” here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PENALTY
9.
Amounts Assessed during the year. . . . . . . . . . . . . . . .
9
INTEREST
10. TOTAL AMOUNT.
10
Add lines 8 and 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.
TOTAL TAXES PAID ON MONTHLY, QUARTERLY, OR SEMIANNUAL RETURNS FOR THE PERIOD
(and the Annual Return if this is an Amended Return) LESS ANY REFUNDS RECEIVED FOR THE
11
11
TAX YEAR. RECONCILIATION ON PAGE 2 MUST BE COMPLETED. . . . . . . . . . . . . .
12.
12
12
Additional assessments paid for the tax year, if included on line 8. . . .
13.
13
13
PENALTIES $ ______________ INTEREST $ ______________ Paid. .
14.
14
14
TOTAL PAYMENTS MADE FOR THE TAX YEAR. (Add lines 11 thru 13)
CREDIT CLAIMED ON ORIGINAL ANNUAL RETURN. (For Amended Return ONLY) .
15.
15
15
NET PAYMENTS MADE. Line 14 minus line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16.
16
CREDIT TO BE REFUNDED. Line 16 minus line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17.
17
ADDITIONAL TAXES DUE. Line 10 minus line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18.
18
PENALTY
FOR LATE FILING ONLY
19.
19
INTEREST
TOTAL AMOUNT DUE AND PAYABLE. (Add lines 18 and 19) . . . . . . . . . . . . . . . . . . . . . . . . . . .
20.
20
AMOUNT OF YOUR PAYMENT
PLEASE ENTER THE
21.
. Attach a check or money order payable to
“HAWAII STATE TAX COLLECTOR” in U.S. dollars drawn on any U.S. bank to Dual Rate Form RV-3. Write “RV”,
the filing period, your Hawaii Tax I.D. No., and your daytime phone number on your check or money order. Mail to: HAWAII DEPARTMENT
OF TAXATION, P.O. BOX 2430, HONOLULU, HI 96804-2430. If you are NOT submitting a payment with this return, enter “0.00” here.
21
DECLARATION: I declare, under the penalties set forth in section 231-36, HRS, that this is a true and correct return, prepared in accordance with the
provisions of the Rental Motor Vehicle and Tour Vehicle Surcharge Tax Law and the rules issued thereunder.
IN THE CASE OF A CORPORATION OR PARTNERSHIP, THIS RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR MEMBER, OR DULY AUTHORIZED AGENT.
(
)
SIGNATURE
TITLE
DATE
DAYTIME PHONE NUMBER
98
DUAL RATE FORM RV-3

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