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 I - GENERAL EXCISE and USE TAXES @ ½ OF 1% (.005)
1. Wholesaling
1
2. Manufacturing
2
3. Producing
3
4. Wholesale Services
4
5
6
7. Sum of Part I, Column c (Taxable Income) — Enter the result here and on page 2, line 24, Column c
7
PART II - GENERAL EXCISE and USE TAXES @ 4% (.04)
8. Retailing
8
9
10. Contracting
10
11
12. Commissions
12
13
14. Other Rentals
14
15
16
17. Sum of Part II, Column c (Taxable Income) — Enter the result here and on page 2, line 25, Column c
17
5. Landed Value of
Imports for Resale
6. Business Activities of
Disabled Persons
9. Services Including
Professional
11. Theater, Amusement
and Broadcasting
13. Transient
Accommodations Rentals
15. Interest and
All Others
16. Landed Value of Imports
for Consumption
Form G-49
(Rev. 2019) 16
DO NOT WRITE IN THIS AREA
16
FORM G-49
(Rev. 2019)
STATE OF HAWAII — DEPARTMENT OF TAXATION
GENERAL EXCISE/USE
ANNUAL RETURN &
RECONCILIATION
• ATTACH CHECK OR MONEY ORDER HERE •
DECLARATION - I declare, under the penalties set forth in section 231-36, HRS, that this return (including any accompanying schedules or statements) has been
examined by me and, to the best of my knowledge and belief, is a true, correct, and complete return, made in good faith for the tax period stated, pursuant to the General
Excise and Use Tax Laws, and the rules issued thereunder.
IN THE CASE OF A CORPORATION OR PARTNERSHIP, THIS RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR MEMBER, OR DULY AUTHORIZED AGENT.
TAX YEAR ENDING
HAWAII TAX I.D. NO.
GE
Last 4 digits of your FEIN or SSN
NAME: ___________________________________
G49_F 2019A 01 VID99
ID NO 99
Continued on page 2 — Parts V & VI MUST be completed
SIGNATURE TITLE DATE DAYTIME PHONE NUMBER
Place an X in this box ONLY if this is an AMENDED return
PRINT FORM
RESET FORM
HELP
t
If negative number, place a minus sign (-)
t
If negative number, place a minus sign (-)
Note: Due date is the 20th day of the 4th month following the close of your tax year
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FORM G-49
(Rev. 2019)
Page 2 of 2
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
PART VI - TOTAL RETURN AND RECONCILIATION
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 $
INTEREST $
29.
30. TOTAL AMOUNT. Add lines 28 and 29. ...................................................................................30.
31. TOTAL PAYMENTS MADE LESS ANY REFUNDS RECEIVED FOR THE TAX YEAR ..................31.
32. CREDIT CLAIMED ON ORIGINAL ANNUAL RETURN. (For Amended Return ONLY) ................... 32.
33. NET PAYMENTS MADE. Line 31 minus line 32 ..............................................................................33.
34. CREDIT TO BE REFUNDED. Line 33 minus line 30 ....................................................................... 34.
35. ADDITIONAL TAXES DUE. Line 30 minus line 33 ..........................................................................35.
36. FOR LATE FILING ONLY
PENALTY $
INTEREST $
36.
37. TOTAL AMOUNT DUE AND PAYABLE (Add lines 35 and 36) ........................................................37.
38. PLEASE ENTER THE AMOUNT OF YOUR PAYMENT. If you are NOT submitting a
payment with this return, please enter “0.00” here. ......................................................................... 38.
39. GRAND TOTAL OF EXEMPTIONS/DEDUCTIONS CLAIMED. (Attach Schedule GE) If Schedule
GE is not attached, exemptions/deductions claimed will be disallowed. ..........................................39.
Form G-49
(Rev. 2019) 16
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
Name:___________________________________________________
Hawaii Tax I.D. No.
Last 4 digits of your FEIN or SSN
TAX YEAR ENDING
G49_F 2019A 02 VID99
ID NO 99
(mm-dd-yy)
t
If negative number, place a minus sign (-)
t
If negative number, place a minus sign (-)
t
If negative number, place a minus sign (-)
t
If negative number, place a minus sign (-)
If negative number, place a minus sign (-)
To enter a value in line 32 mark the "Amended" checkbox on page 1