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FORM (202) <br />FORM <br />(202) <br /> TAXPAYER INFORMATION <br />Taxpayer’s Name Hawaii Identification Number <br />Trade Name or Doing Business as (DBA) Name FEIN/SSN <br />C/O Contact Name <br />Mailing Address (Number and Street)Contact Daytime Telephone Number <br />( ) <br />City, State, and Postal/ZIP Code Contact Fax Number <br />( ) <br />Contact E-mail Address <br /> REPORTING AGENT INFORMATION <br />Reporting Agent’s Name (Name of company or business) Authorized Representative’s Name <br />Reporting Agent’s Mailing Address (Number and Street) Representative’s Hawaii VPID Number <br />City, State, and Postal/Zip Code Representative’s Daytime Telephone Number <br />( ) <br /> AUTHORIZATION TO SIGN AND FILE TAX RETURNS AND TO MAKE PAYMENTS <br />The Reporting Agent and the above named Authorized Representative are authorized to sign and file the below indicated tax returns and to make <br />payments in connection with the below indicated tax returns: <br /> , Periodic Tax Return ....................................for the period beginning <br /> , ...................for the period beginning <br /> AUTHORIZATION AGREEMENT <br />Please read the following Authorization Agreement: <br />The above named taxpayer understands the following responsibilities: <br />•The above named taxpayer is responsible for the actions of the Reporting Agent and the above named Authorized Representative in <br />connection with (a) the above indicated tax returns filed and (b) the related payments made; <br />•All tax returns must be timely filed and all taxes must be timely paid; and <br />•All filed tax returns are true, correct, and complete by the above named taxpayer. <br />The failure of the Reporting Agent and the above named Authorized Representative to comply with tax laws shall not absolve the above named <br />taxpayer of its responsibilities to comply with tax laws. The Reporting Agent and the above named Authorized Representative are authorized to sign <br />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 <br />authorization applies to the above indicated tax returns and related payments beginning with the indicated tax period and remains in effect until the <br />above named taxpayer notifies the Reporting Agent. I authorize the , , to disclose otherwise <br />confidential tax information to the Reporting Agent and the above named Authorized Representative in connection with the transmission of the <br />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 <br />the above named taxpayer, the Reporting Agent and the above named Authorized Representative (a) to sign and file the above indicated tax <br />returns, (b) to make payments in connection with the above indicated tax returns, and (c) to receive confidential information in connection with the <br />transmission of the above indicated tax returns and related payments. <br />Signature Date <br />Print Name Title <br />PART I <br />PART II <br />PART III <br />PART IV