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HomeMy WebLinkAboutForm - Application for Transient Vessel License (Fillable)C.Kimo Alameda, Ph.D. Mayor William V. Brilhante, Jr. Managing Director Merrick Nishimoto Deputy Managing Director County of Hawai'i Department of Liquor Control Hilo Lagoon Centre, 101 Aupuni Street, Unit 230, Hilo, Hawai'i 96720-4261 (808)961-8218 • Fax (808) 961-8684E-Mail: cohdlc@hawaiicounty.gov PROCEDURES TO BE FOLLOWED BY AN APPLICANT FOR A TRANSIENT VESSEL LICENSE Stacie T. Waltjen Director A Transient Vessel (transient vessel means any cruise ship which temporarily docks within the county) license may be granted to the owner of any vessel for the sale of liquor (other than alcohol) on board the vessel while en route within the jurisdictional limits of the State and in any port of the State. Such sales shall be made only for consumption by passengers and their guests on board such a vessel during hours established by the operator/licensee. The application for the license may be made by any agent representing the owner. A written authorization from the owner regarding its authorized agent needs to be submitted with their application. 1.Complete Application for Transient Vessel license. This form needs to benotarized. 2.Submit fee: $25 per day, per port. Please make check payable to the Department of Liquor Control. 3.Applicant's current State Tax Clearance (see attached form A-6). 4.Letter specifying the dock location, date(s) and brief description of the vessel. Hawai'i County is an Equal Opportunity Provider and Employer DEPARTMENT OF LIQUOR CONTROL, COUNTY OF HAWAl'I HILO LAGOON CENTRE, 101 AUPUNI STREET, UNIT 230 HILO, HAWAl'I 96720-4261 OFFICE USE ONLY Filing Fee: $25 per day, per port EMAIL: cohdlc@hawaiicounty.gov Check# Check amount PHONE: (808) 961-8218 FAX: (808) 961-8684 APPLICATION FOR TRANSIENT VESSEL LICENSE TO THE LIQUOR COMMISSION OF THE COUNTY OF HAWAl'I: Application No. ____ _ The undersigned hereby makes application for the following liquor license and makes the following statement: 1.Name of the applicant (company) is: 2.Applicant will do business under the name of: 3.Applicant's mailing address is: ____________________________ _ Telephone: _______ _ FAX: e-mail: _____________ _ 4.The dates and location of port(s): ___________________________ _ 5.Applicant is a/an: __________________________ whose principal(s) are (Individual, Corporation, Partnership, Limited Liability Company, Limited Partnership, Unincorporated Association) Name Title 6.That no person other than the Applicant named herein shall have any interest in the business or license affectedby this application without prior approval of such interest by the Liquor Commission and that no liquor license issued to Applicant has been revoked within the term of two years preceding the date of this application. 7. I hereby certify that the above named applicant, principals and/or persons holding 25% more of stock are twenty­one years of age and have not been convicted of a felony. STATE OF HAWAl'I COUNTY OF HAWAl'I SS: Signature _______________ _ Print Name ______________ _ Title ________________ _ Date _________________ _ ________________ , being first duly sworn, deposes and says that he/she is the Applicant herein named; that he/she is authorized to and does make this verification for and on its behalf; that he/she has read the foregoing application; and that the statements therein set forth are true. Subscribed and sworn to before me this _____ day of _______ , 20 __ _ Notary Public (signature) Notary Public (print name) STATE OF HAWAl'I My commission expires ___________ _ Signature of Applicant before Notary Doc. Date: ______ _ # Pages: ___ _ Name: __________ _ Circuit Doc. Description _____________ _ Signature Dale 03/09 NOTARY CERTIFICATION The County of Hawai'i is an Equal Opportunity Provider and Employer (Page 1 of 2)FORM A-6 (REV. 2022) STATE OF HAWAII — DEPARTMENT OF TAXATION TAX CLEARANCE APPLICATIONForm A-6 can be filed electronically OR for all state, city, or county government contracts, may be obtained through Hawaii Compliance Express. See Instructions.(NOTE: References to “married” and “spouse” are also references to “in a civil union” and “civil union partner,” respectively.) 1. APPLICANT INFORMATION: (PLEASE TYPE OR PRINT CLEARLY) Applicant’s Name Address City/State/Postal/Zip Code DBA/Trade Name 2. TAX IDENTIFICATION NUMBER: HAWAII TAX I.D. # FEDERAL EMPLOYER I.D. # (FEIN) - SOCIAL SECURITY # (SSN) - - 3. APPLICANT IS A/AN: (Check only ONE box )  CORPORATION  S CORPORATION  TAX EXEMPT ORGANIZATION  INDIVIDUAL  PARTNERSHIP  ESTATE  TRUST  LIMITED LIABILITY COMPANY  LIMITED LIABILITY PARTNERSHIP  Single Member LLC disregarded as separate from owner; enter owner’s FEIN/SSN  Subsidiary Corporation; enter parent corporation’s name and FEIN 4. THE TAX CLEARANCE IS REQUIRED FOR: (MUST check at least ONE box)  CITY, COUNTY, OR STATE GOVERNMENT CONTRACT IN HAWAII *  LIQUOR LICENSE  REAL ESTATE LICENSE  CONTRACTOR LICENSE  FINANCIAL CLOSING  PROGRESS PAYMENT  PERSONAL  HAWAII STATE RESIDENCY  FEDERAL CONTRACT  SUBCONTRACT  LOAN  OTHER * IRS APPROVAL STAMP IS ONLY REQUIRED FOR PURPOSES INDICATED BY AN ASTERISK. 5. DECLARATION - I declare that I am either the taxpayer whose name is shown on line 1, or a person authorized under section 231-15.6 or 231-15.7, HRS, to sign on behalf of the taxpayer. If the request applies to a joint return, at least one spouse must sign. I declare to the best of my knowledge and belief, that this is a true, correct, and complete form, made in good faith pursuant to Title 14 of the HRS, and the rules issued thereunder. ( ) ( ) SIGNATURE DATE TELEPHONE FAX PRINT NAME PRINT TITLE: Corporate Officer, General Partner or Member, Individual (Sole Proprietor), Trustee, Executor POWER OF ATTORNEY. If submitted by someone other than a Corporate Officer, General Partner or Member, Individual (Sole Proprietor), Trustee, or Executor, a power of attorney (State of Hawaii, Department of Taxation, Form N-848) must be submitted with this application. If a Tax Clearance is required from the Internal Revenue Service, IRS Form 8821, or IRS Form 2848 is also required. Applications submitted without proper authorization will be sent to the address of record with the taxing authority. UNSIGNED APPLICATIONS WILL NOT BE PROCESSED.PLEASE TYPE OR PRINT CLEARLY — THE FRONT PAGE OF THIS APPLICATION BECOMES THE CERTIFICATE UPON APPROVAL.SEE PAGE 2 ON REVERSE & SEPARATE INSTRUCTIONS. Failure to provide required information on page 2 of this application or as required in the separate instructions to this application will result in a denial of the Tax Clearance request. FOR OFFICE USE ONLY BUSINESS START DATE IN HAWAII IF APPLICABLE/ / HAWAII RETURNS FILED IF APPLICABLE 20______ 20______ 20______ ________ ________ ________ STATE APPROVAL STAMP(State Approval QR Code) You may scan the QR code to authenticate this tax clearance IRS APPROVAL STAMP (City, County, or State Government Contract) ID NO 01 A6_I 2022A 01 VID01 FORM A-6 (REV. 2022) APPLICANT’S NAME FROM PAGE 1 6. CITY, COUNTY, OR STATE GOVERNMENT CONTRACT:  Bid/Entering Into  Ongoing Contract  Completion/Final Payment For completion/final payment of contract, provide the name, agency, and telephone number of the contact person at the State or County Agency. Name: Agency: Telephone Number: 7. LIQUOR LICENSING:  Initial  Renewal  Transfer-Seller  Transfer-Buyer  Special Event 8. CONTRACTOR LICENSING:  Initial  Renewal 9. STATE RESIDENCY: DATE APPLICANT ARRIVED OR RETURNED TO HAWAII 10. ACCOUNTING PERIOD:  Calendar year  Fiscal year ending (MM/DD) 11. TAX EXEMPT ORGANIZATION: A) Provide the Internal Revenue Code section that applies to your exemption (e.g., 501(c)(3)): B) Does your organization file federal Form 990-T, Exempt Organization Business Income Tax Return?  YES  NO C) Is your organization required to file federal Form 990, Return of Organization Exempt From Income Tax, or federal Form 990-EZ, Short Form Return of Organization Exempt From Income Tax?  YES  NO If “YES,” your organization is required to obtain a general excise tax license. Go to line 13. If “NO,” go to line 11D. D) Does your organization have fundraising income?  YES  NO If “YES,” your organization is required to obtain a general excise tax license. 12. INDIVIDUAL: Spouse’s Name SSN 13. IF YOU DO NOT HAVE A GENERAL EXCISE TAX LICENSE AND REQUIRE A TAX CLEARANCE: A) Description of your firm’s business B) Has your firm had any business income in Hawaii?  YES  NO C) Has your firm had an office, inventory, property, employees, or other representatives in the State of Hawaii?  YES  NO D) Has your firm provided any services within the State of Hawaii (e.g., servicing computers, training sessions, etc.)?  YES  NO E) In the current or preceding calendar year has your firm had gross income of $100,000 or more, or entered into 200 or more separate transactions attributable to Hawaii in any of the following, or combination of the following, activities? a) Tangible property delivered in Hawaii; b) Services used or consumed in Hawaii; or c) Intangible property used in Hawaii.  YES  NO Note: If you answer “Yes” to any of the above questions, you are required to apply for a general excise tax license. FILING THE APPLICATION FOR TAX CLEARANCEThe completed application may be mailed, faxed, or submitted in person to the Department of Taxation, Taxpayer Services Branch. Form A-6 may be used to get both a state tax clearance and a federal tax clearance. If you need to get a tax clearance from both agencies, you should submit a separate Form A-6 to each agency. Internal Revenue Service W&I Field Assistance 300 Ala Moana Blvd., #1-128 Honolulu, HI 96850 (By appointment only. To make an appointment, please call 844-545-5640.) Automated phone messaging: 808-466-6011 Fax No.: 855-877-0789 (Page 2 of 2) State Department of Taxation Taxpayer Services Branch P.O. Box 259 Honolulu, HI 96809-0259 Telephone No.: 808-587-4242 Toll Free: 1-800-222-3229 Fax No.: 808-587-1488 or 830 Punchbowl Street Honolulu, HI 96813-5094 $SSOLFDWLRQV DUH DYDLODEOH DW 'HSDUWPHQW RI 7D[DWLRQ DQG ,56 RႈFHV LQ +DZDLL DQG PD\ DOVR EH UHTXHVWHG E\ FDOOLQJ WKH 'HSDUWPHQW RI 7D[DWLRQ RQ Oahu at 808-587-4242 or toll-free at 1-800-222-3229. The Tax Clearance Application, Form A-6, can be downloaded from the Department of Taxation’s website at tax.hawaii.gov.