Form TA-1
(Rev. 2018) 20
DO NOT WRITE IN THIS AREA
20
STATE OF HAWAII — DEPARTMENT OF TAXATION
TRANSIENT ACCOMMODATIONS
TAX RETURN
For periods beginning AFTER December 31, 2017
FORM TA-1
(Rev. 2018)
Column a Column b Column c
DISTRICT GROSS RENTAL OR EXEMPTIONS/DEDUCTIONS TAXABLE PROCEEDS
GROSS RENTAL PROCEEDS (Explain on Reverse Side) (Column a minus Column b)
1. OAHU 1
2.
MAUI, MOLOKAI, LANAI
2
3. HAWAII 3
4.
KAUAI
4
TOTAL FAIR MARKET RENTAL VALUE
5. OAHU DISTRICT ...................................................................................................................... 5.
6. MAUI, MOLOKAI, LANAI DISTRICT ......................................................................................... 6.
7. HAWAII DISTRICT .................................................................................................................... 7.
8. KAUAI DISTRICT ...................................................................................................................... 8.
9. TOTAL AMOUNT TAXABLE. Add Column c of lines 1 through 4 and lines 5
through 8.
Enter result here (but not less than zero). ...............................................................................9.
10. Tax Rate 10. x0.1025
11. TOTAL TAXES DUE. Multiply line 9 by line 10 and enter the result here. If you did
not have any activity for the period, enter “0.00” here ....................................................... 11.
12. Amounts Assessed During the Period...
PENALTY
(For Amended Return ONLY)
INTEREST
12.
13. TOTAL AMOUNT. Add lines 11 and 12. (For Amended Return ONLY) ........................... 13.
14. TOTAL PAYMENTS MADE FOR THE PERIOD (For Amended Return ONLY) ........................ 14.
15. CREDIT TO BE REFUNDED. Line 14 minus line 13 (For Amended Return ONLY) ............... 15.
16. ADDITIONAL TAXES DUE. Line 13 minus line 14 (For Amended Return ONLY) .................. 16.
• ATTACH CHECK OR MONEY ORDER HERE •
PART I — TRANSIENT
ACCOMMODATIONS TAX
PART II — TIMESHARE
OCCUPANCY TAX
PART III — TAX
COMPUTATION
PART IV — ADJUSTMENTS
Continued on page 2 — Parts V & VI MUST be completed
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
Transient Accommodations 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.
Place an “X” in this box ONLY if this is an AMENDED return
PERIOD ENDING
HAWAII TAX I.D. NO.
NAME:____________________________________ Last 4 digits of your FEIN or SSN
SIGNATURE TITLE DATE DAYTIME PHONE NUMBER
Place an “X” in this box ONLY if this is an AMENDED return
TA1_F 2018A 01 VID01
ID NO 01
Clear Form
FORM TA-1
(Rev. 2018)
Form TA-1
Page 2 of 2 20
17. FOR LATE
PENALTY
FILING ONLY
INTEREST
17.
18. TOTAL AMOUNT DUE AND PAYABLE (Original Returns, add lines 11 and 17;
Amended Returns, add lines 16 and 17) ........................................................................................ 18.
19. PLEASE ENTER THE AMOUNT OF YOUR PAYMENT. Attach a check or money order
payable to “HAWAII STATE TAX COLLECTOR” in U.S. dollars drawn on any U.S. bank to
Form TA-1. Write “TA, 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 2430, HONOLULU, HI 96804-2430
or file and pay electronically at tax.hawaii.gov/eservices/. If you are NOT submitting a
payment with this return, please enter “0.00” here. ...................................................................19.
PART V — TOTAL AMOUNT DUE
DISTRICT
/ ED CODE AMOUNT
DISTRICT
/ ED CODE AMOUNT
DISTRICT
/ ED CODE AMOUNT
Grand Total of Exemptions and Deductions Add the amounts above in Part VI and enter here. If more space is needed,
attach a schedule. Include the total deductions claimed from any attachments in this total. (See Instructions) ..........................
PART VI — SCHEDULE OF EXEMPTIONS/DEDUCTIONS
Note: Most ordinary business expenses are NOT DEDUCTIBLE (e.g., materials, supplies, etc.) on your transient accommodations tax return. For more information, see
the Form TA-1 Instructions.
You must explain your exemptions and deductions, otherwise they will be disallowed and you will owe more taxes.
Additional Instructions for Exemptions/Deductions (ED)
For each exemptions/deductions you have claimed, enter:
1. For the “DISTRICT” column, enter the number that represents the Tax District from which the income was earned.
1 = Oahu; 2 = Maui; 3 = Hawaii; and 4 = Kauai
2. For the ED Code please see the list of codes below and enter the corresponding Exemption/Deduction code.
3. Enter your total amount of the exemption/deduction claimed for that District and ED Code.
Example: Taxpayer A received gross rental proceeds of $2,000.00 from the Consul General of the Philippines for lodging on Maui. Taxpayer A
enters the following to justify the deduction entered in Part I, Line 2, Column b of the Transient Accommodations Tax Return:
DISTRICT / ED CODE AMOUNT
2/110 !!!,!!2,000
.
00
Description (HRS) ED Code Description (HRS) ED Code Description (HRS) ED Code
Complimentary Accommodations
(§237D-3(7)) .....100
Diplomats and Consular Ofcials
(§237D-3(8)) ...... 110
Federal or state subsidized lodging
(§237D-3(5)) .................................................120
Health care facilities dened in HRS§321-11(10)
(§237D-3(1)) .................................................130
Nonprot Organization, Lodging provided by a
(§237D-3(3)) .................................................140
School Dormitories (§237D-3(2)) .......................150
Students —
Full-time Post-secondary (§237D-3(6)) ........160
Summer Employment (§237D-3(6)) .............170
Temporary Lodging Allowance for military
(§237D-3(4)) .................................................180
Working Fringe Benet (§237D-3(7)) ................190
Name:___________________________________________________
Hawaii Tax I.D. No.
Last 4 digits of your FEIN or SSN
PERIOD ENDING (MM/YY)
PART VI — SCHEDULE OF EXEMPTIONS/DEDUCTIONS
Note: Most ordinary business expenses are NOT DEDUCTIBLE (e.g., materials, supplies, etc.) on your transient accommodations tax return. For more information, see
the Form TA-1 Instructions.
You must explain your exemptions and deductions, otherwise they will be disallowed and you will owe more taxes.
TA1_F 2018A 02 VID01
ID NO 01