FORM G-45
(Rev. 2019)
Page 2 of 2
Form G-45
(Rev. 2019) 10
PART VI - TOTAL PERIODIC RETURN
TAXABLE INCOME TAX RATE TOTAL TAX
Column c Column d Column e = Column c X Column d
24. Enter the amount from Part I, line 7 .................... x .005 24.
25. Enter the amount from Part II, line 17 ................. x .04 25.
26. Enter the amount from Part III line 18, Column c .............. x .0015 26.
27. COUNTY SURCHARGE TAX. See Instructions for Part IV. Multi district complete Form G-75 ....27.
28. TOTAL TAXES DUE. Add column e of lines 24 through 27 and enter result here (but not less than zero).
If you did not have any activity for the period, enter “0.00” here ............................................... 28.
29. Amounts Assessed During the Period,......................
PENALTY $
(For Amended Return Only)
INTEREST $
29.
30. TOTAL AMOUNT. Add lines 28 and 29. ...................................................................................30.
31. TOTAL PAYMENTS MADE FOR THE PERIOD (For Amended Return ONLY).................................31.
32. CREDIT TO BE REFUNDED. Line 31 minus line 30 (For Amended Return ONLY) ....................... 32.
33. ADDITIONAL TAXES DUE. Line 30 minus line 31 (For Amended Return ONLY) .......................... 33.
34. FOR LATE FILING ONLY
PENALTY $
INTEREST $
34.
35. TOTAL AMOUNT DUE AND PAYABLE (Original Returns, add lines 30 and 34;
Amended Returns, add lines 33 and 34) .......................................................................................... 35.
36. PLEASE ENTER THE AMOUNT OF YOUR PAYMENT. Attach a check or money order payable
to “HAWAII STATE TAX COLLECTOR” in U.S. dollars to Form G-45. Write 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 1425,
HONOLULU, HI 96806-1425 or file and pay electronically at hitax.hawaii.gov.
If you are NOT submitting a payment with this return, please enter “0.00” here. ................... 36.
37. GRAND TOTAL OF EXEMPTIONS/DEDUCTIONS CLAIMED. (Attach Schedule
GE) If Schedule GE is not attached, exemptions/deductions claimed will be disallowed. ...............
37.
Column a Column b Column c
BUSINESS VALUES, GROSS PROCEEDS EXEMPTIONS/DEDUCTIONS TAXABLE INCOME
ACTIVITIES OR GROSS INCOME (Attach Schedule GE) (Column a minus Column b)
PART III - INSURANCE COMMISSIONS @ .15% (.0015)
Enter this amount on line 26, Column c
18
PART IV - COUNTY SURCHARGE — Enter the amounts from Part II, line 17, Column c attributable to each county. Multiply Column c by
the applicable county rate(s) and enter the total of the result(s) on Part VI, line 27, Column e.
19. Oahu (rate = .005) 19
20. Maui 20
21. Hawaii (rate = .005) 21
22. Kauai (rate = .005) 22
18. Insurance
Commissions
Name
Hawaii Tax I.D. No.
Last 4 digits of your FEIN or SSN
PERIOD ENDING
G45_F 2019A 02 VID99
ID NO 99
PART V — SCHEDULE OF ASSIGNMENT OF TAXES BY DISTRICT (ALL taxpayers MUST complete this Part and may be subject to a 10% penalty for noncompliance.)
Place an X in the box of the taxation district in which you have conducted business. IF you did business in MORE THAN ONE district, place an X in the box for “MULTI” and attach Form G-75.
23. Oahu Maui Hawaii Kauai MULTI
23
To enter values in lines 29 or 31 mark the "Amended" checkbox on page 1