Fill in a Valid Hawaii Tax Bb1X Template

FORM BB-1X

(Rev. 2014)

STATE OF HAWAII

BASIC BUSINESS

AMENDED APPLICATION

(NOTE: Reference to “Spouse” also means “Civil Union Partner”.)

This Space For Office Use Only

06

TYPE OR PRINT LEGIBLY

(Mail the completed amended application to the Hawaii Department of Taxation. See back for address.)

1.

ADD to application

 General Excise/Use (GE/Use)

 Transient Accommodations (TA)  Cigarette and Tobacco

 Retail Tobacco Permit

 Employer’s Withholding (WH)

 Liquid Fuel Distributor

 Liquid Fuel Retail Dealer

 Liquor

 Unemployment Insurance (UI)

 Rental Motor Vehicle, Tour Vehicle, and Car-Sharing Vehicle (RVST)

2.

Hawaii Tax I.D. No.

3.

Taxpayer’s/Employer’s Name

W___ ___ ___ ___ ___ ___ ___ ___ – ___ ___

4.

Taxpayer’s Social Security Number

5. Spouse’s Social Security Number

6.

Federal Employer I.D. Number (FEIN)

7.

Mailing address

C/O

Street address or P.O. Box

City

State

Postal/Zip Code + 4

8.

Physical location of business in Hawaii

Street address

City

State

Postal/Zip Code + 4

10. NAICS and business activity (SEE FORM BB-1, LINE 11 INSTRUCTIONS)

11.

Date Business Began in Hawaii

12.

Contact Phone Number

/

/

(

)

13. (a)

Did you acquire an existing business?  Yes  No

14.

No. of establishments or branches in Hawaii

15.

Date employment began in Hawaii

(b)

If yes, was  all or  part of the business acquired?

/

/

(c)

When was it acquired? ____________________ (MM/DD/YYYY)

16.

No. of employees on date employment began

17.

Date first wages paid in Hawaii?

(d) Previous owner’s/business’ name, dba, address, Hawaii Tax I.D. No.,

/

/

and UI Account No. (If you answered “No” to (a) enter N/A)

18.

If no employees, when do you anticipate hiring employees?

/

/

a. General Excise/Use (See Instructions for Form BB-1, lines 1, 32, 33 and 34)

Enter appropriate fee

$

b. Transient Accommodations, enter begin date ___ ___ / ___ ___ / ___ ___

Check only one  $5.00 (1-5 units) OR  $15.00 (6 or more units)

Enter appropriate fee

c. Employer’s Withholding

No fee required

-0-

d. Unemployment Insurance

No fee required

-0-

e. Rental Motor Vehicle, Tour Vehicle, and Car-Sharing Vehicle, enter begin date

___ ___ / ___ ___ / ___ ___

..........Enter $20.00

Tax Payment Voucher. Attach Form VP-1 to this form

$

g. Cigarette and Tobacco, ___ ___ / ___ ___ / ___ ___. Check only one  Dealer

 Wholesaler

Enter $2.50

i. Liquid Fuel Distributor, ___ ___ / ___ ___ / ___ ___. Check all that apply regarding what you intend to do with of any liquid fuel

which will be sold or used within the State.  Produce  Refine  Manufacture  Compound

.......No fee required

-0-

Do you intend to import or cause to be imported into the State any liquid fuel and to sell the same therein?

 Yes

 No

Do you intend to import or cause to be imported into the State any liquid fuel for your own use?

 Yes

 No

Do you intend to acquire liquid fuel from a licensed distributor as a wholesaler and to sell or use the same?

 Yes

 No

j. Liquid Fuel Retail Dealer, be sure to complete line 26

___ ___ / ___ ___ / ___ ___

Enter $5.00

k. Liquor, enter County Liquor License No.

, effective ___ ___ / ___ ___ / ___ ___

Check

 Manufacturer

 Wholesaler

..................................................................................................

Enter $2.50

Miscellaneous Fee Payment Voucher. Attach Form VP-2 to this form

$

TOTAL AMOUNT DUE (Add items f and l) Attach a check or money order made payable in U.S. dollars drawn on any

$

U.S. Bank to “HAWAII STATE TAX COLLECTOR”

CERTIFICATION: The statements contained herein are hereby certified to be correct to the best of the knowledge

Continue on back of this page.

and belief of the undersigned who is duly authorized to sign this amended application.

Type

Number

Date Issued

Effective FYE

Liquor Tax Permit

Cigarette Tax and Tobacco Tax License

Liquid Fuel Distributor’s License

Liquid Fuel Retail Dealer’s Permit