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FORM TA -1 (Rev. 2018) Name: Hawaii Tax I.D. No. TA Last 4 digits of your FEIN or SSN PERIOD ENDING (MM/YY) W 17. FOR LATE PENALTY FILING ONLY 17. p INTEREST M 18. TOTAL AMOUNT DUE AND PAYABLE (Original Returns, add lines 11 and 17; Amended Returns, add lines 16 and 17)........................................................................................18. a O19. PLEASE ENTERTHE 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. I- 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 a payment with this return, please enter "0.00" here....................................................................19. 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. 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) .......................... 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, Cohunn b of the Transient Accommodations Tax Return: DISTRICT/ ED CODE AMOUNT D/I I0 =IED)000.00 Description (HRS) ED Code Description (HRS) ED Code Description (HRS) ED Code Complimentary Accommodations (§237D-3(7)) .....100 Nonprofit Organization, Lodging provided by a Temporary Lodging Allowance for military Diplomats and Consular Officials (§237D-3(8))......110 (§237D -3(3)) .................................................140 (§237D-3(4)) ................................................. 180 Federal or state subsidized lodging School Dormitories (§237D-3(2)) .......................150 Working Fringe Benefit (§237D-3(7)) ................190 (§237D -3(5)) .................................................120 Students— Health care facilities defined in HRS§321-11(10) Full-time Post -secondary (§237D-3(6))........160 (§237D -3(1)) .................................................130 Summer Employment (§237D-3(6)) ............. 170 ID NO 01 Form TA -1 Page 2 of 220 TAi_I 2018A 02 V1 D01