HTAT-3 Bulk Filers Authorization Form

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FORM COUNTY OF HAWAII - DEPARTMENT OF FINANCE TRANSIENT � HTAT-3 ACCOMMODATIONS INTERNAL CONTROL DIVISION (2021) HTAT Reporting Agent AuthorizationF""'� TAXPAYER INFORMATION Taxpayer's Name Hawaii TAT Identification Number Trade Name or Doing Business as (DBA) Name FEIN/SSN C/o Contact Name Mailing Address (Number and Street) Contact Daytime Telephone Number City, State, and Postal/ZIP Code Contact Fax Number Contact E-mail Address REPORTING AGENT INFORMATION Reporting Agent's Name (Name of company or business) Reporting Agent's Mailing Address (Number and Street) City, State, and Postal/Zip Code LUAW AUTHORIZATION TO SIGN AND FILE TAX RETURNS AND TO MAKE PAYMENTS Authorized Representative's Name Representative's Hawaii VPID Number Representative's Daytime Telephone Number The Reporting Agent and the above named Authorized Representative are authorized to sign and file the below indicated tax returns and to make payments in connection with the below indicated tax returns: ❑ TA -1, Transient Accommodations Tax Periodic Tax Return .................................... for the period beginning ❑ TA -2, Transient Accommodations Tax Annual Return & Reconciliation ................... for the period beginning LMOM AUTHORIZATION AGREEMENT Please read the following Authorization Agreement: The above named taxpayer understands the following responsibilities: • The above named taxpayer is responsible for the actions of the Reporting Agent and the above named Authorized Representative in connection with (a) the above indicated tax returns filed and (b) the related payments made; • All tax returns must be timely filed and all taxes must be timely paid; and • All filed tax returns are true, correct, and complete by the above named taxpayer. The failure of the Reporting Agent and the above named Authorized Representative to comply with tax laws shall not absolve the above named taxpayer of its responsibilities to comply with tax laws. The Reporting Agent and the above named Authorized Representative are authorized to sign and file the above indicated tax returns and to make payments in connection with the above indicated tax returns for the above named taxpayer. This authorization applies to the above indicated tax returns and related payments beginning with the indicated tax period and remains in effect until the above named taxpayer notifies the Reporting Agent. I authorize the County of Hawai'i, Department of Finance, to disclose otherwise confidential tax information to the Reporting Agent and the above named Authorized Representative in connection with the transmission of the above indicated tax returns and related payments. I hereby certify under the penalties of perjury that I have the authority to authorize, on behalf of the above named taxpayer, the Reporting Agent and the above named Authorized Representative (a) to sign and file the above indicated tax returns, (b) to make payments in connection with the above indicated tax returns, and (c) to receive confidential information in connection with the transmission of the above indicated tax returns and related payments. Signature Print Name Date Title FORM HTAT-3 (2021)