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COUNTY OF HAWAI'I — DEPARTMENT OF FINANCE <br />FORM TRANSIENT ACCOMMODATIONS <br />HCTAT-1 <br />(revised 1/2024) TAX PAYMENT VOUCHER <br />Name (Please print): Period Ending: _ _ / _ _ / <br />Hawaii State Tax I.D. Number: TA— — — — <br />❑ Please check here if this payment is due to an amended return. <br />Mailing Address: <br />Phone number: ( ) <br />STREET UNIT TYPE/NO. CITY <br />Email address: <br />STATE ZIP CODE COUNTRY <br />❑ Please check here if you would like to opt in to receive electronic mailings (statements, billing, etc.) <br />Line 1. Enter the net rental proceeds from your State Form TA-1, line 3, column c ............. <br />Line 2. Enter the total fair market rental value from your State Form TA-1, line 7 .............. <br />Line 3. Total subject to HCTAT. Add lines 1 and 2. Enter the total here ....................... <br />Line 4. Multiply line 3 by 0.03 (3%) and enter your total HCTAT DUE ........................ <br />Line 5. Penalty and Interest........................................................ <br />Line 6. Add line's 4 & 5 TOTAL DUE ................................................ <br />Line 7. Total payments made for this period ............................................ <br />Line 8. Subtract line 7 from line 6. Additional Payment/Refund Due ......................... <br />8 a) ADDITIONAL TAXES DUE: _ <br />8 b) CREDIT TO BE REFUNDED: <br />Line 9. Total Amount of Payment/Refund requested ................................. <br />Attach this voucher with check or money order payable to <br />"DIRECTOR OF FINANCE" Write your name, "HCTAT", <br />the filing period, a contact phone number, and your Hawaii <br />Tax I.D. Number on your check or money order. <br />2 <br />Form HCTAT-1 (revised 1/2024) <br />