FORM G-6                                          STATE OF HAWAII — DEPARTMENT OF TAXATION 
(REV. 2020)
                           INFORMATION REQUIRED TO FILE FOR AN 
                           EXEMPTION FROM GENERAL EXCISE TAXES 
                   PLEASE READ THE INSTRUCTIONS (FORM G-6A) BEFORE COMPLETING THIS APPLICATION
 
                                                  1. Federal employer identification number  2. Hawaii Tax I.D. number (if any) 
                                                                                                 GE __ __ __-__ __ __-__ __ __ __-__ __
 3. Full name of organization (exactly as it appears in your organizing document)

 4. Care of (if applicable)

 5. Mailing address (number and street), city or town, state, and postal/ZIP code

 6. Business address (number and street), city or town, state, and postal/ZIP code

 7. Organization’s website                                                                                          8. Date organization’s Hawaii activity began

 9. Primary contact
     a. Name and title                            b. Telephone number                                               c. E-mail address
                                                      (      )
 10. Organization is applying for a GET exemption as an organization described under Hawaii Revised Statutes (check one):
        § 237-23(a)(3)                  § 237-23(a)(4)                  § 237-23(a)(5)                  § 237-23(a)(6)                 § 237-23(a)(7)  
 11. Organization has received/applied for a federal income tax exemption as an organization described under Internal Revenue Code (check one):
        §501(c)(3)                               §501(c)(4)                               §501(c)(5) Agricultural or horticultural organization                 §501(c)(6)                                    
        §501(c)(8)                               §501(c)(12) Potable water company                               Other: ______________________ (specify)
        
        12. The following items MUST be submitted with the completed application: (See instructions for more 
        information.)
        A. Twenty dollars ($20) registration fee when filing the application for a new general excise tax account. Please make 
        sure you do not already have an active general excise tax account.
        B.  An IRS determination letter granting federal tax exemption (check one):
         Attach when request.
         Was requested on (MM/DD/YY) ____________, but has not been received. Attach a statement to explain.
         Was not requested or required. Attach a statement to explain why. 
        C. Statement to request retroactive approval - If you are requesting retroactive approval, see the instructions.
        D. Articles of Organization
        E. Amendments to articles of organization (if any)
        F. Bylaws and amendments – If the organization has not adopted bylaws, enclose a statement to that effect.

                                                  SCHEDULE A

                                                  STATEMENT OF ORGANIZATION
Date of Inception: 
Under the Laws of: 
If Part of a Central (National) Organization, Indicate Name of the Central Organization: 
Month of Organization’s Accounting Year End: 
Character of Organization:                        hitax.hawaii.gov
Purpose for Which Organized (describe fully):                                                                                                                        
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                                                                                                                                                                    FORM G-6

 FORM G-6                                                                              PAGE 2
(REV. 2020)
                                              SCHEDULE A (Continued)

Actual Activities in Hawaii (describe fully):                                                    
                                                                                                 
Types of Income in Hawaii (describe fully):                                                      
                                                                                                 
Disposition of Income in Hawaii (describe fully):                                                
                                                                                                 
Date of Last Amendment to Bylaws: 

                                                  SCHEDULE B 

              LIST OF OFFICERS,                   DIRECTORS  OR TRUSTEES                
                                                           Daytime                     Time Devoted 
 Name in Full                     Address         Telephone No.     Office Held Salary to Duties

                                                  hitax.hawaii.gov

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                                                                                       FORM G-6

FORM G-6                                   SCHEDULE C                                                           PAGE 3
(REV. 2020)
                COMPARATIVE BALANCE SHEET FOR HAWAII ACTIVITIES
Complete the following balance sheet for the organization’s last two completed tax years. If your organization was recently 
formed and has not completed a full tax year, enter the most current information available in column (B).  Be sure to enter 
the date(s) for the information provided.  If the organization was recently formed and has not acquired any assets or in-
curred any liabilities, please state this on Schedule C.  See the instructions (Form G-6A) for more information.
                                                       (A)                   (B)
                                                       For Year Ending       For Year Ending
                     ITEMS                             ____ / ____ / ____    ____ / ____ / ____
                                                       (Year before the last (Last completed 
                                                       completed tax year)   tax year)
                HAWAII ASSETS
Cash
Accounts/grants/pledges receivable 
Inventories
Investments (attach an itemized list)
Furniture & Equipment
Land & Buildings
Other assets (attach an itemized list)

                                           TOTAL ASSETS
           HAWAII LIABILITIES & NET WORTH
Accounts payable
Contributions/gifts/grants payable
Deferred revenue
Mortgages & notes payable (attach an itemized list)
Other liabilities (attach an itemized list)

                                           hitax.hawaii.gov

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                TOTAL LIABILITIES & NET WORTH

                                                                                                                FORM G-6

FORM G-6                                                                                    PAGE 4
(REV. 2020)
                                             SCHEDULE D
COMPARATIVE STATEMENT OF RECEIPTS AND DISBURSEMENTS FOR HAWAII ACTIVITIES
Complete the comparative statement of receipts and disbursements for the organization’s Hawaii activities for the last two 
completed tax years.  If the organization recently started its activity in Hawaii or was recently formed (less than two com-
plete years of activity in Hawaii), prepare a projected budget of anticipated income and related expenses for the organiza-
tion’s Hawaii activities for 2 years.
                                                             (A)                   (B)
                                                             For Year Ending       For Year Ending
                    ITEMS                                    ____ / ____ / ____    ____ / ____ / ____
                                                             (Year before the last (Last completed 
                                                             completed tax year)   tax year)
HAWAII RECEIPTS
Gifts/contributions received
Grants
Unusual grants
Membership dues/fees
Fundraising/special events (attach an itemized list)
Gross receipts from admissions
Gross receipts from the sale of merchandise
Gross receipts from services performed
Gross rental income
Other revenue (attach an itemized list)

                                     TOTAL RECEIPTS
HAWAII DISBURSEMENTS
Fundraising expenses
Contributions/gifts/grants paid out (attach an itemized list)
Salaries and wages
Occupancy (rent, utilities, etc.)
Supplies
Insurance
Professional fees
Other disbursements (attach an itemized list)

                                       hitax.hawaii.gov

           Do Not File This CopyForm G-6 must be filed at

                                     TOTAL EXPENSES
                 RECEIPTS OVER DISBURSEMENTS

                                                                                            FORM G-6