FORM X-4
7/2012
Instructions: Application must be typewritten or printed in black ink, and must be legible. All signatures must be in black ink.
Submit original application together with the appropriate fee(s).
The reinstatement period is within two years after the involuntary dissolution/cancellation/revocation or administrative
termination/dissolution/cancellation of the entity. Only domestic entities may apply for reinstatement.
Execution:
For corporations, document must be signed by at least one officer of the corporation.
For general partnerships, must be signed by at least one general partner.
For limited liability partnerships, must be signed and certified by at least one partner.
For limited partnerships, must be signed by at least one general partner.
For limited liability limited partnerships, must be signed by at least one general partner.
For limited liability companies, must be signed and certified by at least one manager of a manager-managed company or by
at least one member of a member-managed company.
Line 1. Check the appropriate box.
Line 2. State the full name of the business entity.
Line 3. State the date of dissolution/cancellation/revocation/termination.
Line 4. State the years (month, day, year) that annual statements/reports are delinquent.
All delinquent annual statements/reports must be filed with this application.
Line 5. A certificate or other writing from the Department of Taxation must be filed with this application.
Filing Fees: Filing fees are not refundable. Make checks payable to DEPARTMENT OF COMMERCE AND
CONSUMER AFFAIRS.
Profit Corporation ($25)
Nonprofit Corporation ($10)
General Partnership ($10)
Limited Liability Partnership ($25)
Limited Partnership ($10)
Limited Liability Limited Partnership ($10)
Limited Liability Company ($25)
Dishonored Check Fee ($25)
For any questions call (808) 586-2727. Neighbor islands may call the following numbers followed by 6-2727 and the # sign:
Kauai 274-3141; Maui 984-2400; Hawaii 974-4000, Lanai & Molokai 1-800-468-4644 (toll free).
Fax: (808) 586-2733
Email Address:
breg@dcca.hawaii.gov
NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE
DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST.
ALL BUSINESS REGISTRATION FILINGS ARE OPEN TO PUBLIC INSPECTION. (SECTION 92F-11, HRS)
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