Hawaii Tax Clearance Application Online Form 2012

Clear Form FORM A-6 REV. 2012 STATE OF HAWAII DEPARTMENT OF TAXATION TAX CLEARANCE APPLICATION Form A-6 can be filed electronically. See Instructions. A tax clearance must be obtained through Hawaii Compliance Express for all state city or county government contracts. See Instructions. NOTE References to married unmarried and spouse also means in a civil union not in a civil union and civil union partner respectively. FOR OFFICE USE ONLY BUSINESS START DATE IN HAWAII IF APPLICABLE / / 1. APPLICANT INFORMATION PLEASE TYPE OR PRINT CLEARLY HAWAII RETURNS FILED 20 20 20 Applicant s Name Address STATE APPROVAL STAMP Not valid unless stamped City/State/Postal/Zip Code DBA/Trade Name 2. NO. OF CERTIFIED COPIES REQUESTED 6. SIGNATURE SIGNATURE DATE TELEPHONE FAX PRINT NAME PRINT TITLE Corporate Officer General Partner or Member Individual Sole Proprietor Trustee Executor POWER OF ATTORNEY. If submitted by someone other than a Corporate Officer General Partner or Member Individual Sole Proprietor Trustee or Executor a power of attorney State of Hawaii Department of Taxation Form N-848 must be submitted with this application. If a Tax Clearance is required from the Internal Revenue Service IRS Form 8821 or IRS Form 2848 is also required. Applications submitted without proper authorization will be sent to the address of record with the taxing authority. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED. PLEASE TYPE OR PRINT CLEARLY THE FRONT PAGE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL. SEE PAGE 2 ON REVERSE SEPARATE INSTRUCTIONS. Failure to provide required information on page 2 of this application or as required in the separate instructions to this application will result in a denial of the Tax Clearance request. THE TAX CLEARANCE IS REQUIRED FOR MUST CHECK AT LEAST ONE BOX CERTIFIED COPY STAMP REAL ESTATE LICENSE CONTRACTOR LICENSE LIQUOR LICENSE FINANCIAL CLOSING PROGRESS PAYMENT BULK SALES HAWAII STATE RESIDENCY FEDERAL CONTRACT PERSONAL SUBCONTRACT LOAN OTHER ATTACH FORM G-8A REPORT OF BULK SALE OR TRANSFER 5. NO. OF CERTIFIED COPIES REQUESTED 6. SIGNATURE SIGNATURE DATE TELEPHONE FAX PRINT NAME PRINT TITLE Corporate Officer General Partner or Member Individual Sole Proprietor Trustee Executor POWER OF ATTORNEY. If submitted by someone other than a Corporate Officer General Partner or Member Individual Sole Proprietor Trustee or Executor a power of attorney State of Hawaii Department of Taxation Form N-848 must be submitted with this application. If a Tax Clearance is required from the Internal Revenue Service IRS Form 8821 or IRS Form 2848 is also required. Applications submitted without proper authorization will be sent to the address of record with the taxing authority. APPLICANT IS A/AN IRS APPROVAL STAMP MUST CHECK ONE BOX CORPORATION TAX EXEMPT ORGANIZATION INDIVIDUAL PARTNERSHIP ESTATE TRUST LIMITED LIABILITY COMPANY Single Member LLC disregarded as separate from owner enter owner s FEIN/SSN Subsidiary Corporation enter parent corporation s name and FEIN 4. THE TAX CLEARANCE IS REQUIRED FOR MUST CHECK AT LEAST ONE BOX CERTIFIED COPY STAMP REAL ESTATE LICENSE CONTRACTOR LICENSE LIQUOR LICENSE FINANCIAL CLOSING PROGRESS PAYMENT BULK SALES HAWAII STATE RESIDENCY FEDERAL CONTRACT PERSONAL SUBCONTRACT LOAN OTHER ATTACH FORM G-8A REPORT OF BULK SALE OR TRANSFER 5. NO. OF CERTIFIED COPIES REQUESTED 6. SIGNATURE SIGNATURE DATE TELEPHONE FAX PRINT NAME PRINT TITLE Corporate Officer General Partner or Member Individual Sole Proprietor Trustee Executor POWER OF ATTORNEY. TAX IDENTIFICATION NUMBER HAWAII TAX ID W - FEDERAL EMPLOYER ID FEIN SOCIAL SECURITY SSN - - 3. APPLICANT IS A/AN IRS APPROVAL STAMP MUST CHECK ONE BOX CORPORATION TAX EXEMPT ORGANIZATION INDIVIDUAL PARTNERSHIP ESTATE TRUST LIMITED LIABILITY COMPANY Single Member LLC disregarded as separate from owner enter owner s FEIN/SSN Subsidiary Corporation enter parent corporation s name and FEIN 4. THE TAX CLEARANCE IS REQUIRED FOR MUST CHECK AT LEAST ONE BOX CERTIFIED COPY STAMP REAL ESTATE LICENSE CONTRACTOR LICENSE LIQUOR LICENSE FINANCIAL CLOSING PROGRESS PAYMENT BULK SALES HAWAII STATE RESIDENCY FEDERAL CONTRACT PERSONAL SUBCONTRACT LOAN OTHER ATTACH FORM G-8A REPORT OF BULK SALE OR TRANSFER 5. If submitted by someone other than a Corporate Officer General Partner or Member Individual Sole Proprietor Trustee or Executor a power of attorney State of Hawaii Department of Taxation Form N-848 must be submitted with this application. If a Tax Clearance is required from the Internal Revenue Service IRS Form 8821 or IRS Form 2848 is also required. Applications submitted without proper authorization will be sent to the address of record with the taxing authority. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED. PLEASE TYPE OR PRINT CLEARLY THE FRONT PAGE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL. SEE PAGE 2 ON REVERSE SEPARATE INSTRUCTIONS. Failure to provide required information on page 2 of this application or as required in the separate instructions to this application will result in a denial of the Tax Clearance request. Page 1 of 2 APPLICANT S NAME FROM PAGE 1 Initial Renewal Transfer-Seller Transfer-Buyer Special Event 9. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED. PLEASE TYPE OR PRINT CLEARLY THE FRONT PAGE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL. SEE PAGE 2 ON REVERSE SEPARATE INSTRUCTIONS. Failure to provide required information on page 2 of this application or as required in the separate instructions to this application will result in a denial of the Tax Clearance request. Page 1 of 2 APPLICANT S NAME FROM PAGE 1 Initial Renewal Transfer-Seller Transfer-Buyer Special Event 9. STATE RESIDENCY DATE APPLICANT ARRIVED OR RETURNED TO HAWAII 10. ACCOUNTING PERIOD Calendar year Fiscal year ending MM/DD 11.