Clear Form

FORM G-17                         STATE OF HAWAII — DEPARTMENT OF TAXATION
(REV. 2016)

                                  RESALE CERTIFICATE FOR GOODS 
                                             GENERAL FORM 1 
                                             (PLEASE PRINT OR TYPE)

To  
             Name of Seller

             Address of Seller                                                        Date of this Certificate

       City                 State            Postal/ZIP Code

    The undersigned hereby certifies the following under the penalties set forth in section 231-36, Hawaii Revised Statutes 
(HRS), as Purchaser or as an authorized agent or representative of the named Purchaser:

    That the Purchaser is the holder of Hawaii Tax Identification No. GE __ __ __ -__ __ __ -__ __ __ __ - __ __ under the 
General Excise Tax Law and subject to the taxing jurisdiction of the State.

    That the nature and character of the Purchaser’s business is:

    That this Certificate, until revoked by notice in writing, shall apply to all purchases of tangible personal property which 
the Purchaser shall purchase from the Seller named above except those orders which the Purchaser specifies by notice in 
writing that this Certificate does not apply.

    That all of the purchases of tangible personal property to which this Certificate applies:

              are purchases for resale at retail or leases under Chapter 237, HRS; and/or

              are purchases for resale at wholesale under Chapter 237, HRS;

    That the Purchaser, pursuant to section 237-13(2)(F)(i), HRS, and section 18-237-13-02(d)(2)(B), Hawaii Administrative 
Rules, shall pay to the seller the amount of any additional tax imposed upon the seller with respect to any transactions 
covered by this certificate.

             Name of Purchaser                                                                Signature

             Address of Purchaser                                                     Print Name of Signatory

  City                      State            Postal/ZIP Code Title (Owner, Partner or Member, Officer, or Duly Authorized Agent)Date

             Seller should retain this Certificate for Seller’s files. Do NOT send to the Department of Taxation.

                                                                                                                                FORM G-17