FORM P-64A
Form P-64A STATE OF HAWAII—DEPARTMENT OF TAXATION
BOC Document Number
(REV. 2019)
CONVEYANCE TAX CERTIFICATE
(Please Type or Print)
PART I
1. TAX MAP KEY INFORMATION:
TAX MAP KEY
Z S PLAT PARCEL CPR NO.
ISLAND ____________ APT. NO. ___________
CLIP THIS FORM TO DOCUMENT TO BE RECORDED AND MAIL OR DELIVER TO
THE BUREAU OF CONVEYANCES. DO NOT STAPLE. All parts of this Form MUST
be completed. If any area is incomplete, Form P-64A will not be accepted.
Before completing this form, please read the Instructions for Form P-64A and
Form P-64B. To obtain the Instructions, go to the Department of Taxation’s website at
tax.hawaii.gov or call the Department to request forms at
808-587-4242 or 1-800-222-3229 (toll-free).
2. NAMES/EMAIL OF PARTIES TO THE DOCUMENT:
SELLER(S) / TRANSFEROR(S) / GRANTOR(S), ETC. PURCHASER(S) / TRANSFEREE(S) / GRANTEE(S), ETC.
__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________
__________________________________________________ __________________________________________________
3. REAL PROPERTY TAX INFORMATION:
If the document will not be recorded, please provide: (1) land area; and (2) address or short legal description of property:
________________
________________________________________________________________________________________________________________
Please provide mailing address for assessment notice (do not enter “Same” or “No Change”):
NAME ADDRESS POSTAL/ZIP CODE
Please provide real property tax billing address, if different from assessment address (do not enter “Same” or “No Change”):
NAME ADDRESS POSTAL/ZIP CODE
PART II. TAX COMPUTATION AND BALANCE DUE:
1. DATE OF TRANSACTION (For Transactions dated prior to July 1, 2009 see Instructions for rates.) ................... 1.
2. Amount from Page 2, Part IV, line 1, 2c, 3c, or 4c .................................. 2.
3. Less: personal property included in amount on line 2, if applicable ...... 3.
4. Difference — Actual and full consideration (line 2 minus line 3 ) ........................................................................ 4.
5. By checking this box and signing below, the Purchaser(s)/Transferee(s)/Grantee(s), etc. attest under penalties set forth in the declaration below,
that this transaction, is EITHER:
Not a sale of a condominium or single family residence OR
The purchaser is ELIGIBLE for a county real property tax homeowner's exemption with respect to the property conveyed. .............. 5. ä
6. Enter the applicable Conveyance Tax Rate: (For Transactions dated prior to July 1, 2009 see Instructions for rates.)
6.
7. Conveyance Tax (Multiply line 4 by line 6 and round to the nearest ten cents ($.10) ............................................ 7.
8a. Penalty. For late filing (See Instructions) .............................................. 8a.
8b. Interest. For late payment (See Instructions) ....................................... 8b. 8.
9. Total Balance Due (Add lines 7 and 8) (Minimum tax due is $1.00) ...................................................................... 9.
SIGNATURE(S) - Seller(s)/Transferor(s)/Grantor(s), Etc.
(If agent is signing, print or type name below signature)
DAYTIME PHONE NO.:
(
)
-
EMAIL:
If the amount on line 4 is:
And the box on line 5 . . . .
is NOT checked. IS checked.
Less than $600,000 .0015 .0010
$600,000 or more but less than $1,000,000 .0025 .0020
$1,000,000 or more but less than $2,000,000 .0040 .0030
$2,000,000 or more but less than $4,000,000 .0060 .0050
$4,000,000 or more but less than $6,000,000 .0085 .0070
$6,000,000 or more but less than $10,000,000 .0110 .0090
$10,000,000 or more .0125 .0100
I (We) declare, under the penalties prescribed for false declaration in section 231-36, Hawaii Revised Statutes (HRS), that this certificate (including accompanying schedules or statements)
has been examined by me (us) and, to the best of my (our) knowledge and belief, is a true, correct, and complete certificate, made in good faith, for the actual and full consideration paid
on the conveyance to which this certificate is appended, pursuant to the Conveyance Tax Law, chapter 247, HRS. Note: You must have a power of attorney if signing as agent.
x 0.0 __ __ __
DECLARATION
SIGNATURE(S) - Purchaser(s)/Transferee(s)/Grantee(s), Etc.
(If agent is signing, print or type name below signature)
DAYTIME PHONE NO.:
(
)
-
EMAIL:
