Hawaii Employee's Statement to Employer Concerning Nonresidence in the State of Hawaii

Employee's Statement to Employer Concerning Nonresidence in the State of Hawaii
Form HW-6, Rev. 2022, Employee's Statement to Employer Concerning Nonresidence in the State of Hawaii
Clear Form
FORM HW-6
(REV. 2023)

HW6_I 2023A 01 VID01

STATE OF HAWAII — DEPARTMENT OF TAXATION

EMPLOYEE’S STATEMENT TO EMPLOYER CONCERNING
NONRESIDENCE IN THE STATE OF HAWAII
(Please Type or Print.)
ALL lines must be completed, unless otherwise instructed. See separate Instructions.
NOTE: References to “married” and “spouse” are also references to
“in a civil union” and “civil union partner,” respectively.

Full Name		

Year
2024
Social Security Number

Present Home Address (Street, City, State, and Postal/ZIP Code)

Name of Employer and Employer’s Address (Street, City, State, and Postal/ZIP Code)

1.	 Are you currently a resident of Hawaii? (See Instructions for a discussion of a “Resident.”)............................................................ Yes 	No 
	
If you checked “Yes,” stop here. Do not complete the rest of this form. Do not file this form with your employer.
Withholding is required on your wages.
2.	 Have you ever been a resident of Hawaii?........................................................................................................................................ Yes 	No 
	
If you checked “Yes,” answer questions 3 through 34. If you checked “No,” answer questions 3 through 23.
3.	 Address of your domicile which is your true, fixed, permanent home and principal establishment and to which
place you intend to return whenever you are absent	
4.	 If you are married or have dependents, state their relationships to you and their present addresses.
Otherwise, enter “Not applicable” on line 4a.
		
Relationship to You			
Present Address
a. 	 		
	
		
b. 			
	
		
5.	 Can you be claimed as a dependent on another person’s income tax return? (See Instructions.)................................................... Yes 	No 
	
If you checked “Yes,” is the person who can claim you as a dependent a Hawaii resident?............................................................ Yes 	No 
6.	 Were you physically present in Hawaii at any time during the calendar years 2020 through 2024?................................................ Yes 	No 
	
If you checked “Yes,” state approximately how many days, in the aggregate, you spent in Hawaii during
each of the following years:	
2020	
	2021	
	2022	
	2023	
	2024	
	
If you were present in Hawaii more than 200 days during the year, explain the reason you were in Hawaii.	
	

			

7.	 Do you own real property in Hawaii?................................................................................................................................................. Yes 	No 
	
If you checked “Yes,” indicate the type of property:  Residential  Rental   Other (Explain) 	
8.	 Do you own real property outside Hawaii?........................................................................................................................................ Yes 	No 
	
If you checked “Yes,” indicate the type of property:  Residential  Rental   Other (Explain) 	
	Note:  If you check “Yes” to any of the questions 9 through 17, please state the reason on the dotted line next to the check boxes.
9.	 Do you have a Hawaii driver’s license?............................................................................................................................................. Yes 	No 
10.	 Have you purchased Hawaii auto license plates?............................................................................................................................. Yes 	No 
11.	 Do your children attend school in Hawaii?........................................................................................................................................ Yes 	No 
12.	 Do you have any checking accounts or safe deposit boxes with banks, or other financial institutions, on
which you have listed a Hawaii address?.......................................................................................................................................... Yes 	No 
13.	 Do you have a Hawaii telephone listing?.......................................................................................................................................... Yes 	No 
14.	 Are you a member of any social, business, or church groups in Hawaii?......................................................................................... Yes 	No 
15.	 Are you registered to vote in Hawaii? (Except for Presidential Elections as provided under Chapter 14,
Hawaii Revised Statutes).................................................................................................................................................................. Yes 	No 
16.	 Will your estate be admitted to probate in Hawaii?........................................................................................................................... Yes 	No 
17.	 Do you file Hawaii resident income tax returns?............................................................................................................................... Yes 	No 
18.	 With which Internal Revenue Service Center do you file your federal income tax returns?	
19.	 Are you a U.S. citizen?...................................................................................................................................................................... Yes 	No 
	
If you checked “No,” are you a permanent resident alien of the U.S.?.............................................................................................. Yes 	No 
	
If you are not a permanent resident alien of the U.S., state the type of visa you have.	

		
ID NO 01
FORM HW-6 (Rev. 2023)

FORM HW-6
(REV. 2023)		

PAGE 2

20.	 Are you in Hawaii in compliance with military or naval orders of the United States?........................................................................ Yes 	No 
	
If you checked “Yes,” enclose a true copy of your military or naval orders.
21.	 Are you in Hawaii while engaged in aviation or navigation?............................................................................................................. Yes 	No 
	
If you checked “Yes,” enclose a true copy of a letter from your employer describing your services
performed in aviation or navigation.
22.	 Are you in Hawaii while a student at any institution of learning?....................................................................................................... Yes 	No 
	
If you checked “Yes,” enclose a true copy of a document certified by the officials of the
school, college, or university, evidencing your enrollment in their class or course.
23.	 Are you the spouse of a nonresident service member, crew member, or student who came to Hawaii;
your principal reason for moving to Hawaii was to accompany your spouse; and it is your intention to
leave Hawaii when your spouse is transferred, discharged, or graduates?...................................................................................... Yes 	No 
	
If you checked “Yes,” enclose true copies of your spouse’s military or naval orders and Leave and Earning
Statement, and your unexpired military spouse identification card; a letter from your spouse’s employer
describing your spouse’s services performed in aviation or navigation; or document certified by
the officials of the school, college, or university evidencing your spouse’s enrollment in their class or course.
	Note:  If you checked “No” to question 2, stop here. If you checked “Yes” to question 2, answer questions 24 through 34.
24.	 List the years you were a resident of Hawaii.	
25.	 Explain why you gave up your Hawaii residency.	
26.	 If you were domiciled in Hawaii, on what date did you terminate your Hawaii domicile?	
27.	 Did you move out of Hawaii to your new domicile?........................................................................................................................... Yes 	No 
	
If you checked “Yes,” on what date? (Note: This date may be different than the date in number 26.)	
28.	 What specific steps did you take to terminate your Hawaii domicile and on what date did you take such steps?	
	

			

29.	 In what state or country did you establish your new domicile?	
30.	 When did you begin working in that state or country?	
31.	 Did your family move out of Hawaii to your new domicile?............................................................................................................... Yes 	No 
	
If you checked “Yes,” on what date?____________________________
32.	 In the state or country you are now claiming as your new domicile, have you:
	
a.	 Purchased a home?.................................................................................................................................................................. Yes 	No 
			 If you checked “Yes,” on what date was it purchased?__________________________
	
b. 	 Sent your children to schools in that state or country?............................................................................................................. Yes 	No 
	
c. 	 Joined any social, business, or church groups in that state or country?................................................................................... Yes 	No 
	
d. 	 Registered to vote in that state or country?.............................................................................................................................. Yes 	No 
33.	 What other specific steps did you take to establish your new domicile?	
	

			

34.	 Please enter any other facts or circumstances relating to your change of domicile that you feel should be
considered.	
I declare under the penalties of section 231-36 of the Hawaii Revised Statutes, that I have answered all the above questions which I
am required to answer, and that my answers are true and correct.

Employee’s Signature: 	

Date:

		
FORM HW-6 (Rev. 2023)