Clear Form
FORM A-6                                                                                                                                                     STATE OF HAWAII — DEPARTMENT OF TAXATION 
(REV. 2022)                                                                                                                                                                                                                                                     FOR OFFICE USE ONLY
                                                                                                                                                             TAX CLEARANCE APPLICATION                                                                          BUSINESS START DATE IN HAWAII 
                                                                                                                                                           Form A-6 can be filed electronically OR for all state, city, or county government 
                                                                                                                                                           contracts, may be obtained through Hawaii Compliance Express. See Instructions.                      IF APPLICABLE
                                                                                                                                                           (NOTE: References to “married” and “spouse” are also references to                                   /    /
                                                                                                                                                             “in a civil union” and “civil union partner,” respectively.)
                                                                                                                                                                                                                                                                HAWAII RETURNS FILED 
1.  APPLICANT INFORMATION:      (PLEASE TYPE OR PRINT CLEARLY)                                                                                                                                                                                                  IF APPLICABLE
                                                                                                                                                                                                                                                                20______  20______  20______
Applicant’s Name    
                                                                                                                                                                                                                                                                ________  ________  ________
Address 

City/State/Postal/Zip Code                                                                                                                                                                                                                                      STATE APPROVAL STAMP
                                                                                                                                                                                                                                                                (State Approval QR Code)
DBA/Trade Name                                                                                                                                                

                                                                        2.  TAX IDENTIFICATION NUMBER:

                                                                        HAWAII TAX I.D. #                                                                                                         

                                                                        FEDERAL EMPLOYER I.D. # (FEIN)                                                            -                                  

                                                                        (SSN)                -          -                     # SOCIAL SECURITY              
                                                                                                                                                                                                                                                                You may scan the QR code to authenticate this tax clearance
                                                                        3.  APPLICANT IS A/AN:     (Check only ONE box)
                                                                                                                                                                                                                                                                IRS APPROVAL STAMP
  CORPORATION                                                                                                                                                  S CORPORATION        TAX EXEMPT ORGANIZATION                                                  (City, County, or State Government Contract)
  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.
                                                                                                                                                                                                                                                                      A6_I 2022A 01 VID01

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.

                                                                                                                                                                               (Page 1 of 2)
                                                                                                                                                              ID NO 01

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 CLEARANCE
The 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.
                   State Department of Taxation                                     Internal Revenue Service 
                   Taxpayer Services Branch                                         W&I Field Assistance 
                   P.O. Box 259                                                     300 Ala Moana Blvd., #1-128 
                   Honolulu, HI  96809-0259                                         Honolulu, HI  96850 
                                                                                     
                   Telephone No.: 808-587-4242                                      (By appointment only. To make an  
                   Toll Free: 1-800-222-3229                                        appointment, please call 844-545-5640.) 
                   Fax No.: 808-587-1488                                             
                         or                                                         Automated phone messaging: 808-466-6011 
                   830 Punchbowl Street                                             Fax No.: 855-877-0789 
                   Honolulu, HI  96813-5094

Applications are available at Department of Taxation and IRS offices in Hawaii, and may also be requested by calling the Department of Taxation on 
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.

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