DO NOT WRITE IN THIS AREA
01
FORM GEW-TA-RV-1
(REV. 2019)
FORM GEW-TA-RV-1
01
STATE OF HAWAII
DEPARTMENT OF TAXATION
NOTIFICATION OF CANCELLATION
OF TAX LICENSES AND TAX PERMITS
Name
Trade Name or Doing Business As (DBA) Name
( )
Telephone Number
CANCEL MY TAX ACCOUNT(S) AS INDICATED BELOW:
Tax Type
License, Registration,
or Permit
License/Registration/Permit Number
Effective Date
(MM/DD/YYYY)
Example: Cigarette & Tobacco Retail Dealer’s Permit TR-123-456-7890-01P 12/31/2019
Instructions to Cancel Tax Account(s):
Column 1, Tax Type — Enter the tax type for each license, registration or permit that you are cancelling.
Column 2, License, Registration or Permit — Enter the type of account being cancelled. Specify whether the account is a license, a
registration, or a permit.
Column 3, License/Registration/Permit Number — Enter the license, registration, or permit number for the account you are cancelling.
Column 4, Effective Date — Enter the effective date for the cancellation of the license, registration or permit.
The effective date of
cancellation is the last day of the filing period for the last tax return that is required to be filed, even if no tax is due. For example, if the last
required tax return is for the fourth quarter of 2019, the effective date of cancellation would be 12/31/2019 (not 1/1/2020).
Signature, Filing, & Payment Requirements: This form must be signed and sent to the Department of Taxation (Department) with the
tax license(s), registration(s) or permit(s) that you are cancelling. An unsigned cancellation notice will not be accepted. All required
periodic (monthly, quarterly, or semiannual) and annual tax returns must be filed up to the date of cancellation and all taxes due paid in
full. If the required returns and taxes due are not filed and paid in full, the tax license(s), registration(s) or permit(s) will be cancelled as
requested, but your tax account(s) will remain open for actions by the Department to the extent permitted by law.
Signature of Owner, Partner or Member, Officer, or Duly Authorized Agent
Print Name of Signatory
Title Date
Mailing Address:
Hawaii Department of Taxation
Licensing Section
P. O. Box 1425
Honolulu, HI 96806-1425
GEWTARV1_I 2019A 01 VID01 ID NO 01
