HTAT-2 Bulk Filers Registration Form

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FORMCOUNTY OF HAWAII — DEPARTMENT OF FINANCE HTAT-2 Bulk Filers Program (BFP) Registration (2021) a ` OF PART I — PARTICIPANT INFORMATION ❑ NEW Registration ❑ AMENDED Registration Business Name FEIN Business Address (Number, Street, City, State, Postal/ZIP Code) Business Phone Number Check all that apply: ❑ Reporting Agent (Tax preparer, property management company, payroll company, and others who prepare returns for multiple clients or multiple locations for the same client.) ❑ Direct Transmitter (Company that may "transmit" the bulk file to HTAT for the Reporting Agent. A Reporting Agent may also be its own transmitter.) ❑ Software Developer (Company that designs, researches, programs, tests, and maintains the software system.) PART II — PRIMARY CONTACT INFORMATION Name and Title Phone Number w/extension E-mail Address Fax Number PART III —TECHNICAL CONTACT INFORMATION Name and Title Phone Number w/extension E-mail Address Hawai'i Bulk Filer ID Number (For Amended Only) PART IV — DECLARATION Print Name of Authorized Individual Title Signature Date Authorized Individual's Phone Number SSN/PTIN/VPID of Authorized Individual Under the penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete and am authorized to make and sign this statement on behalf of the participant. I state that the participant and its employees will comply with all the requirements for the BFP and understand that acceptance for participation in BFP is not transferable. The participant and its employees further understand that non-compliance with any requirements will result in the cancellation of the approval to participate in the BFP program. The participants and its employees further understand that pursuant to section 231-8.5, Hawaii Revised Statutes, the act of electronically filing tax returns on behalf of any taxpayer shall have the same validity and consequences as the actual signing by the taxpayer. The County of Hawaii, Department of Finance reserves the right to revoke or suspend participation in the BFP. Department Use Only Registration Date Added to BFP HTAT Blk Filer ID Number IRS -assigned EFIN or ETIN Employee Initials FORM HTAT-2 (2021)