Hawaii General Excise/Use, Employer's Withholding, Transient Accommodations and Rental Motor Vehicle & Tour Vehicle Surcharge Appli

General Excise/Use, Employer's Withholding, Transient Accommodations and Rental Motor Vehicle & Tour Vehicle Surcharge Appli
Form GEW-TA-RV-5 Rev 2014 General Excise/Use, Employer's Withholding, Transient Accommodations and Rental Motor Vehicle & Tour Vehicle Surcharge Appli
Clear Form
FORM GEW-TA-RV-5
(REV. 2014)

STATE OF HAWAII
DEPARTMENT OF TAXATION

DO NOT WRITE IN THIS AREA	

03

GENERAL EXCISE/USE, EMPLOYER’S
WITHHOLDING, TRANSIENT ACCOMMODATIONS
AND RENTAL MOTOR VEHICLE, TOUR VEHICLE &
CAR-SHARING VEHICLE SURCHARGE
APPLICATION CHANGES
IMPORTANT: File this form ONLY if there are changes to your license application (Form BB-1).
Name:

Hawaii Tax I.D. No.:

W __ __ __ __ __ __ __ __ -__ __
PLEASE CHANGE MY:
1a.



1b. Reason for Name Change:

Name to:

(Attach documentation of name change, such as marriage certificate, DCCA filing, etc.)

(NOTE: If a new FEIN is required, a new license must be obtained.)
2.
4.



Trade Name or Doing Business As (DBA) Name to:



E-mail Address to:

 Business Phone Number to:

3a.

(

)

3b.
to:
5.

 Residential Phone Number
(



)
Primary NAICS Code to:

__ __ __ __ __ __
6.



Accounting Period to:    


7.



Accounting Method to:

8.

  General Excise Filing Period for:



Calendar Year  
Accrual





Fiscal Year Ending

Cash  As of:

 9.

*

   Withholding Filing Period for:

*

10.  	 Transient Accommodations Filing Period for:

Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
As of

*

11.  	 Rental Motor Vehicle, Tour Vehicle & Car-Sharing Vehicle
Filing Period for:

Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
As of

To:

	Monthly
	Quarterly
	Semi-annually
From:

Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
As of

.

.
From:

Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
As of

__ __ / __ __   As of:

	 Monthly (Annual tax exceeds $4,000.)
	 Quarterly (Annual tax does not exceed $4,000.)
	 Semi-annually (Annual tax not more than $2,000.)
To:

	Monthly
	Quarterly

	 Monthly (Annual tax exceeds $5,000.)
	 Quarterly (Annual tax does not exceed $5,000.)

From:

To:

	Monthly
	Quarterly
	Semi-annually
From:

	 Monthly (Annual tax exceeds $4,000.)
	 Quarterly (Annual tax does not exceed $4,000.)
	 Semi-annually (Annual tax not more than $2,000.)
To:

	Monthly
	Quarterly
	Semi-annually

	 Monthly (Annual tax exceeds $4,000.)
	 Quarterly (Annual tax does not exceed $4,000.)
	 Semi-annually (Annual tax not more than $2,000.)

*

* NOTE: The requested change will take effect after the current filing period is over. The filing frequency cannot be changed retroactively.

PLEASE ADD:
12.



Federal Employer I.D. No.

__ __ -__ __ __ __ __ __ __
13.

Parent Corporation’s: FEIN
 

__ __ -__ __ __ __ __ __ __
15.

(NOTE: If your FEIN has changed, you must apply for a new license. This line is ONLY for those applicants
who did not have a FEIN at the time the original application was filed.)
Hawaii Tax I.D. No.
W __ __ __ __ __ __ __ __ - __ __

 New Partners, Members, or Corporate Officers (List on page 2 of
this form.)

14.



  Trade Name or Doing Business As (DBA) Name:

16.  

Address(es) for my Rental Real Property, Rental Motor Vehicle,
Tour Vehicle and/or Car-Sharing Vehicle Business, and Transient
Accommodations. (List on page 2 of this form.)

18.  

Address(es) for my Rental Real Property, Rental Motor Vehicle,
Tour Vehicle and/or Car-Sharing Vehicle Business, and Transient
Accommodations. (List on page 2 of this form.)

PLEASE DELETE:
17.



19.



Partners, Members, or Corporate Officers (List on page 2 of this
form.)
  Trade Name or Doing Business As (DBA) Name:

Signature of Owner, Partner or Member, Officer, or Duly Authorized Agent

HAWAII DEPARTMENT OF TAXATION
P.O. BOX 1425
HONOLULU, HI 96806-1425

Print Name of Signatory
Title

MAILING ADDRESS

Date

FORM GEW-TA-RV-5

03

FORM GEW-TA-RV-5
(REV. 2014)

PAGE 2

15. List the social security number (SSN), name, title, address, city, state, and postal/zip code of each partner, member, or corporate
officer to be ADDED. If the partner or member is not an individual, list the partner’s or member’s federal employer identification
number (FEIN). If more space is needed, attach a separate schedule.
SSN/FEIN
Name
Title
Address

16. List by island, the address of each rental real property, rental motor vehicle, tour vehicle and/or car-sharing vehicle (RVST), business, and transient accommodation (TA) to be ADDED. If you are adding a TA or RVST, place a check mark in the appropriate
column below. If more space is needed, attach a separate schedule.
Check if
Check if
Address
Island
TA
RVST

17. List the social security number (SSN), name, title, and address of each partner, member, or corporate officer to be DELETED.
If the partner or member is not an individual, list the partner’s or member’s FEIN. If more space is needed, attach a separate
schedule.
SSN/FEIN
Name
Title
Address

18. List by island, the address of each rental real property, rental motor vehicle, tour vehicle and/or car-sharing vehicle (RVST), business, and transient accommodation (TA) to be DELETED. If you are deleting a TA or RVST, place a check mark in the appropriate
column below. If more space is needed, attach a separate schedule.
Check if
Check if
Address
Island
TA
RVST

FORM GEW-TA-RV-5

03