Hawaii Tax Clearance Application

Tax Clearance Application
Form A-6, Rev. 2022, Tax Clearance Application
Clear Form
STATE OF HAWAII — DEPARTMENT OF TAXATION

FORM A-6
(REV. 2022)

FOR OFFICE USE ONLY

TAX CLEARANCE APPLICATION

BUSINESS START DATE IN HAWAII
IF APPLICABLE

Form A-6 can be filed electronically OR for all state, city, or county government
contracts, may be obtained through Hawaii Compliance Express. See Instructions.
(NOTE: References to “married” and “spouse” are also references to
“in a civil union” and “civil union partner,” respectively.)

/   /

HAWAII RETURNS FILED
IF APPLICABLE
20______ 20______ 20______

1. APPLICANT INFORMATION:     (PLEASE TYPE OR PRINT CLEARLY)
Applicant’s Name  		

________ ________ ________

Address  		

STATE APPROVAL STAMP
(State Approval QR Code)

City/State/Postal/Zip Code  	
DBA/Trade Name 	
2. TAX IDENTIFICATION NUMBER:
HAWAII TAX I.D. #                                         
FEDERAL EMPLOYER I.D. # (FEIN)         -                           
SOCIAL SECURITY # (SSN)             -        -                 
3. APPLICANT IS A/AN:

You may scan the QR code to authenticate this tax clearance

(Check only ONE box)

IRS APPROVAL STAMP

 CORPORATION	
  S CORPORATION	
  TAX EXEMPT ORGANIZATION
 INDIVIDUAL	
 PARTNERSHIP	
 ESTATE	
 TRUST
  LIMITED LIABILITY COMPANY	
  LIMITED LIABILITY PARTNERSHIP
  Single Member LLC disregarded as separate from owner; enter owner’s FEIN/SSN	       
  Subsidiary Corporation; enter parent corporation’s name and FEIN	                

(City, County, or State Government Contract)

                                                
4. THE TAX CLEARANCE IS REQUIRED FOR:

(MUST check at least ONE box)

  CITY, COUNTY, OR STATE GOVERNMENT CONTRACT IN HAWAII *	
  REAL ESTATE LICENSE	
  CONTRACTOR LICENSE	
  PROGRESS PAYMENT	
 PERSONAL	
  FEDERAL CONTRACT	
 SUBCONTRACT	
 OTHER 		

  LIQUOR LICENSE
  FINANCIAL CLOSING
  HAWAII STATE RESIDENCY
 LOAN

* IRS APPROVAL STAMP IS ONLY REQUIRED FOR PURPOSES INDICATED BY AN ASTERISK.

A6_I 2022A 01 VID01

5. DECLARATION - I declare that I am either the taxpayer whose name is shown on line 1, or a person authorized under section 231-15.6 or 231-15.7, HRS, to sign on

behalf of the taxpayer. If the request applies to a joint return, at least one spouse must sign. I declare to the best of my knowledge and belief, that this is a true, correct,
and complete form, made in good faith pursuant to Title 14 of the HRS, and the rules issued thereunder.

				(   )    		(   )    
SIGNATURE		 DATE		TELEPHONE		FAX	
PRINT NAME		

PRINT TITLE: Corporate Officer, General Partner or Member, Individual (Sole Proprietor), Trustee, Executor	

POWER OF ATTORNEY. If submitted by someone other than a Corporate Officer, General Partner or Member, Individual (Sole Proprietor), Trustee,
or Executor, a power of attorney (State of Hawaii, Department of Taxation, Form N-848) must be submitted with this application. If a Tax Clearance is
required from the Internal Revenue Service, IRS Form 8821, or IRS Form 2848 is also required. Applications submitted without proper authorization
will be sent to the address of record with the taxing authority. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED.
PLEASE TYPE OR PRINT CLEARLY  —  THE FRONT PAGE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL.
SEE PAGE 2 ON REVERSE & SEPARATE INSTRUCTIONS. Failure to provide required information on page 2 of this application or as required in the
separate instructions to this application will result in a denial of the Tax Clearance request.

ID NO 01

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FORM A-6
(REV. 2022)
						
	

APPLICANT’S NAME FROM PAGE 1  			

6.	

CITY, COUNTY, OR STATE GOVERNMENT CONTRACT:    
Bid/Entering Into     
Ongoing Contract     
Completion/Final Payment
For completion/final payment of contract, provide the name, agency, and telephone number of the contact person at the State or County Agency.
Name:                                       Agency:                                     Telephone Number:                          
7.	 LIQUOR LICENSING:	
 Initial	
 Renewal	
  Transfer-Seller	
  Transfer-Buyer	
  Special Event
8.	 CONTRACTOR LICENSING:	  Initial	
 Renewal
9.	 STATE RESIDENCY:	
DATE APPLICANT ARRIVED OR RETURNED TO HAWAII  			
10.	 ACCOUNTING PERIOD:	
  Calendar year	
  Fiscal year ending (MM/DD)  	 	
11.	 TAX EXEMPT ORGANIZATION:
	
A)	 Provide the Internal Revenue Code section that applies to your exemption (e.g., 501(c)(3)):	       
	
B)	 Does your organization file federal Form 990-T, Exempt Organization Business Income Tax Return?     YES    NO
	C)	 Is your organization required to file federal Form 990, Return of Organization Exempt From Income Tax, or
	 federal Form 990-EZ, Short Form Return of Organization Exempt From Income Tax?     YES    NO
	 If “YES,” your organization is required to obtain a general excise tax license. Go to line 13.
	 If “NO,” go to line 11D.
	
D)	 Does your organization have fundraising income?     YES    NO
	 If “YES,” your organization is required to obtain a general excise tax license.
12.	INDIVIDUAL:    Spouse’s Name  		 	 SSN  	
13.	 IF YOU DO NOT HAVE A GENERAL EXCISE TAX LICENSE AND REQUIRE A TAX CLEARANCE:
	A)	 Description of your firm’s business				
	
B)	 Has your firm had any business income in Hawaii?				
  YES    NO
	
C)	 Has your firm had an office, inventory, property, employees, or other representatives in the State of Hawaii?	
  YES    NO
	
D)	 Has your firm provided any services within the State of Hawaii (e.g., servicing computers, training sessions, etc.)?	
  YES    NO
	
E)	 In the current or preceding calendar year has your firm had gross income of $100,000 or more, or entered into
			 200 or more separate transactions attributable to Hawaii in any of the following, or combination of the following,
			 activities? a) Tangible property delivered in Hawaii; b) Services used or consumed in Hawaii; or c) Intangible property
			 used in Hawaii.					
  YES    NO
	
Note: If you answer “Yes” to any of the above questions, you are required to apply for a general excise tax license.

FILING THE APPLICATION FOR TAX CLEARANCE

The completed application may be mailed, faxed, or submitted in person to the Department of Taxation, Taxpayer Services Branch. Form A-6 may be used
to get both a state tax clearance and a federal tax clearance. If you need to get a tax clearance from both agencies, you should submit a separate Form
A-6 to each agency.
State Department of Taxation
Taxpayer Services Branch
P.O. Box 259
Honolulu, HI 96809-0259

Internal Revenue Service
W&I Field Assistance
300 Ala Moana Blvd., #1-128
Honolulu, HI 96850

Telephone No.: 808-587-4242
Toll Free: 1-800-222-3229
Fax No.: 808-587-1488
     or
830 Punchbowl Street
Honolulu, HI 96813-5094

(By appointment only. To make an
appointment, please call 844-545-5640.)
Automated phone messaging: 808-466-6011
Fax No.: 855-877-0789

Applications are available at Department of Taxation and IRS offices in Hawaii, and may also be requested by calling the Department of Taxation on
Oahu at 808-587-4242 or toll-free at 1-800-222-3229. The Tax Clearance Application, Form A-6, can be downloaded from the Department of Taxation’s
website at tax.hawaii.gov.

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