Form Ta-1 - Transient Accommodations Tax Return
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2THIS SPACE FOR DATE RECEIVED STAMP
20
FORM TA-1
STATE OF HAWAII — DEPARTMENT OF TAXATION
TRANSIENT ACCOMMODATIONS
(REV. 2010)
TAX RETURN
QBF101
HAWAII TAX I.D. NO. W
_ _ _ _ _ _ _ _ - _ _
Check this box if this is an AMENDED Return
LAST 4 DIGITS OF YOUR FEIN OR SSN:
__ __ __ __
NAME:_________________________________________________
Month Quarter or Semiannual Period Ending
__ __ / __ __
(MM/YY)
(Do not combine your income for more than one filing period on this return.)
TAXATION
GROSS RENTAL OR
EXEMPTIONS/DEDUCTIONS
TAXABLE PROCEEDS
RATE
TAXES
GROSS RENTAL PROCEEDS
(EXPLAIN ON REVERSE SIDE)
DISTRICT
(b)
( a)
(c)
(d)
PART I — For Periods ending BEFORE July 1, 2009
1 OAHU
.0725
1
2 MAUI, MOLOKAI, LANAI
.0725
2
3 HAWAII
.0725
3
4 KAUAI
.0725
4
PART II — For Periods beginning AFTER June 30, 2009 and ending BEFORE July 1, 2010
5 OAHU
.0825
5
6 MAUI, MOLOKAI, LANAI
.0825
6
7 HAWAII
.0825
7
8 KAUAI
.0825
8
PART III — For Periods beginning AFTER June 30, 2010
9 OAHU
.0925
9
10 MAUI, MOLOKAI, LANAI
.0925
10
11 HAWAII
.0925
11
12 KAUAI
.0925
12
PART IV — TIMESHARE OCCUPANCY TAX
(To be completed by Plan Managers ONLY)
13 Enter the total taxes for Timeshare Occupancy from page 2, Part VI, line 28, here . . . . . . . . . . . . . . . . . .
13
PART V — TOTAL PERIODIC RETURN
TOTAL TAXES DUE.
14.
Add Column (d) of lines 1 through 13 and enter result here. If you did not have any
activity for the period, enter “0.00” here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
PENALTY
15. Amounts Assessed During the Period . . . . . . . . . . . . . .
15
(For Amended Return ONLY)
INTEREST
TOTAL AMOUNT.
16.
Add lines 14 and 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
17. TOTAL PAYMENTS MADE FOR THE PERIOD (For Amended Return ONLY). . . . . . . . . . . . . . . . . . . . .
17
18. CREDIT TO BE REFUNDED. Line 17 minus line 16 (For Amended Return ONLY) . . . . . . . . . . . . . . . . .
18
19. ADDITIONAL TAXES DUE. Line 16 minus line 17 (For Amended Return ONLY) . . . . . . . . . . . . . . . . . .
19
PENALTY
FOR LATE FILING ONLY
20.
INTEREST
20
21. TOTAL AMOUNT DUE AND PAYABLE (Original Returns, add lines 16 and 20;
Amended Returns, add lines 19 and 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
AMOUNT OF YOUR PAYMENT
22. PLEASE ENTER THE
. Attach a check or money order payable to
“HAWAII STATE TAX COLLECTOR” in U.S. dollars drawn on any U.S. bank to Form TA-1. Write “TA”, the filing
period, and your Hawaii Tax I.D. No. on your check or money order. Mail to: HAWAII DEPARTMENT OF TAXATION,
P. O. Box 2430, HONOLULU, HI 96804-2430 or file and pay electronically at If you are
NOT submitting a payment with this return, please enter “0.00” here. . . . . . . . . . . . . . . . . . . . . . .
22
GRAND TOTAL OF EXEMPTIONS/DEDUCTIONS CLAIMED from back of form.
23.
. . . . . .
23
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 Transient Accommodations Tax Law, Chapter 237D, HRS and the rules issued thereunder.
A CORPORATION OR PARTNERSHIP TAX RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR MEMBER, OR DULY AUTHORIZED AGENT OF SUCH ENTITY.
(
)
SIGNATURE
TITLE
DATE
DAYTIME PHONE NUMBER
20
FORM TA-1
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