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STATE OF HAWAII — DEPARTMENT OF TAXATION
FORM
N-30
CORPORATION INCOME TAX RETURN
(REV. 2012)
2012
CALENDAR YEAR
or other tax year beginning ________________ , 2012
and ending _________________ , 20 ____
CBF121
AMENDED Return (Attach Sch AMD)
NOL Carryback
Name
Federal Employer I.D. No.
Business Activity Code No. (Use code shown on federal
Dba or C/O
form 1120 or 1120A)
Address (number and street)
Date business began in Hawaii
City or town, State, and Postal/ZIP Code. If foreign address, see Instructions.
Hawaii Business Activity
Hawaii Tax I.D. No.
THIS RETURN IS (CHECK BOX, IF APPLICABLE):
For a multi-state corporation using separate accounting.
A combined return of a unitary group of corporations. (See instructions)
A consolidated return. (Domestic (Hawaii) corporations only.)
A separate return of a member corporation of a unitary group. (See instructions)
(Attach a copy of Hawaii Forms N-303 and N-304 for each subsidiary)
FOR LINES 1 - 5 and 7 - 10, ENTER AMOUNTS FROM COMPARABLE LINES ON FEDERAL RETURN.
(a) Merchant card and third party payments
1
1(a)
00
(b) Gross receipts or sales not reported on line 1a
1(b)
00
(c) Total Add lines 1a and 1b
1(c)
00
(d) Returns and allowances plus any other adjustments
1(d)
00
(e) Line 1c minus line 1d
1(e)
00
Cost of goods sold and/or operations
2
2
00
Interest
3
3
00
Gross rents
4
4
00
Gross royalties
5
5
00
(a) Capital gain net income (attach Hawaii Schedule D)
6
6(a)
00
(b) Net gain or (loss) from Hawaii Schedule D-1, Part II, line 19 (attach Schedule D-1)
6(b)
00
Other income
7
7
00
TOTAL INCOME
8
TOTAL INCOME
8
00
TOTAL DEDUCTIONS
9
TOTAL DEDUCTIONS
9
00
Taxable income before Hawaii adjustments — Line 8 minus line 9 Enter here and on Schedule J, line 1
10
10
00
TOTAL TAX (Schedule J, line 23)
11
TOTAL TAX
11
00
Total refundable credits from Schedule CR, line 22
12
12
00
Line 11 minus line 12 If line 13 is zero or less, see Instructions
13
13
00
Total nonrefundable credits from Schedule CR, line 14
14
14
00
Line 13 minus line 14
15
15
00
(a) 2011 overpayment allowed as a credit
16
16(a)
00
(b) 2012 estimated tax payments (including any Form N-288A witholdings. See Instructions)
16(b)
00
(c) Payments with extension (attach Form N-301)
16(c)
00
(d) Total (Add lines 16(a) through 16(c))
TOTAL
16(d)
00
Estimated tax penalty (see Instructions) Check if Form N-220 is attached
17
17
00
TAX DUE (If the total of lines 15 and 17 are larger than line 16(d)), enter AMOUNT OWED
18
18
00
If line 16(d) is larger than the total of lines 15 and 17, enter AMOUNT OVERPAID See Instructions
19
19
00
20
Enter amount of line 19 you want Credited to 2013 estimated tax20(a) $
Refunded
20(b)
00
Amount paid (overpaid) on original return — AMENDED RETURN ONLY (See Instructions Attach Sch AMD)
21
21
00
BALANCE DUE (REFUND) with amended return (See Instructions Attach Sch AMD)
22
22
00
I declare, under the penalties set forth in section 231-36, HRS, that this return (including any accompanying schedules or statements) has been examined by me and, to the best of my
knowledge and belief, is true, correct, and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge
Print or type name and title of officer
Date
Signature of officer
May the Hawaii Department of Taxation discuss this return with the preparer shown below? (See page 2 of the Instructions) This designation does not replace Form N-848
Yes
No
Preparer’s signature
Preparer’s identification no.
and date
Check if
Paid
Print Preparer’s Name
self-employed
Preparer’s
Firm’s name (or yours,
Federal
Information
E.I. No.
if self-employed)
Phone no.
Address and ZIP Code
FORM N-30