FORM G-49                                              STATE OF HAWAII — DEPARTMENT OF TAXATION                                     DO NOT WRITE IN THIS AREA 
                                     (REV. 2023)
                                                                                                                                                                                                         16
                                                                                                             GENERAL EXCISE/USE 
                                                                                                              ANNUAL RETURN &
                                                                                                                  RECONCILIATION 
                                     G49_I 2023A 01 VID01

                                                            Fill in this oval ONLY if this is an AMENDED return
                                                                         (mm dd yy)

                                        TAX YEAR ENDING                                                                                    HAWAII TAX I.D. NO. GE
                                        Last 4 digits of your FEIN or SSN    
                                                                                                                                                                                              ID NO 01
                                        NAME: ___________________________________
                                                                                  Column a                                                         Column b                           Column c
    BUSINESS                                                             VALUES, GROSS PROCEEDS                                                    EXEMPTIONS/DEDUCTIONS        TAXABLE INCOME
    ACTIVITIES                                                           OR GROSS INCOME                                                           (Attach Schedule GE)         (Column a minus Column b)
PART I - GENERAL EXCISE and USE TAXES @ ½ OF 1% (.005)
                                                                                                                                                                                                           Neg
                                     1.  Wholesaling                                                                                                                                                            1
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     2.  Manufacturing                                                                                                                                                          2
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     3.  Producing                                                                                                                                                              3
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     4.  Wholesale Services                                                                                                                                                     4
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     5.  Landed Value of 
                                         Imports for Resale                                                                                                                                                     5
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     6.  Business Activities of
                                          Disabled Persons                                                                                                                                                      6
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     7.  Sum of Part I, Column c (Taxable Income)  —  Enter the result here and on page 2, line 24, Column c                                                                    7
                                                                                                                                                                                                   .00 
PART II - GENERAL EXCISE and USE TAXES @ 4% (.04)
                                                                                                                                                                                                           Neg
• ATTACH CHECK OR MONEY ORDER HERE • 8.  Retailing                                                                                                                                                              8
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     9.  Services Including 
                                         Professional                                                                                                                                                           9
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     10. Contracting                                                                                                                                                            10
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     11. Theater, Amusement  
                                         and Broadcasting                                                                                                                                                       11
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     12. Commissions                                                                                                                                                            12
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     13. Transient  
                                         Accommodations Rentals                                                                                                                                                 13
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     14. Other Rentals                                                                                                                                                          14
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     15. Interest and  
                                         All Others                                                                                                                                                             15
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     16. Landed Value of Imports       
                                         for Consumption                                                                                                                                                        16
                                                                                                                  .00                                                   .00                        .00
                                                                                                                                                                                                           Neg
                                     17. Sum of Part II, Column c        (Taxable Income) — Enter the result here and on page 2, line 25, Column c                                                              17
                                                                                                                                                                                                   .00 
                                     DECLARATION - I declare, under the penalties set forth in section 231-36, HRS, that this return (including any accompanying schedules or statements) has been 
                                     examined by me and, to the best of my knowledge and belief, is a true, correct, and complete return, made in good faith for the tax period stated, pursuant to the General 
                                     Excise and Use Tax Laws, and the rules issued thereunder.
                                     IN THE CASE OF A CORPORATION OR PARTNERSHIP, THIS RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR MEMBER, OR DULY AUTHORIZED AGENT.
                                                            SIGNATURE                                                    TITLE                     DATE                                  DAYTIME PHONE NUMBER 

                                                                                                                                                                                              FORM G-49 
                                      G491H7V9                    Continued on page 2 — Parts V & VI MUST be completed                                                                        (REV. 2023)  
                                                                                                                                                                                                         16

 FORM G-49                                                                                                                                                                   Page 2 of 2
 (REV. 2023)
                        Name:___________________________________________________
                                                                                                                                                             ID NO 01
                        Hawaii Tax I.D. No.   GE                                                                                                                    (mm dd yy)
 G49_I 2023A 02 VID01   Last 4 digits of your FEIN or SSN                                                                                            TAX YEAR ENDING
                                                                                                                                                                    
                                          Column a                                                          Column b                                         Column c
    BUSINESS                   VALUES, GROSS PROCEEDS                                                       EXEMPTIONS/DEDUCTIONS                            TAXABLE INCOME
    ACTIVITIES                    OR GROSS INCOME                                                           (Attach Schedule GE)                             (Column a minus Column b)
 PART III - INSURANCE COMMISSIONS @ .15% (.0015)                                                                                                         Enter this amount on line 26, Column c
 18.  Insurance                                                                                                                                                                                Neg
      Commissions                                                                                                                                                                                 18
                                                                                     .00                                                             .00                     .00
 PART IV - COUNTY SURCHARGE — Enter the amounts from Part II, line 17, Column c attributable to each county. Multiply Column c by  
                                                               the applicable county rate(s) and enter the total of the result(s) on Part VI, line 27, Column e.
                                                                                                                                                                                               Neg
 19. Oahu (rate = .005)                                                                                                                                                                           19
                                                                                     .00                                                             .00                     .00 Neg
 20. Maui (rate = .005)                                                                                                                                                                           20
                                                                                     .00                                                             .00                     .00 Neg
 21. Hawaii (rate = .005)                                                                                                                                                                         21
                                                                                     .00                                                             .00                     .00
                                                                                                                                                                                               Neg
 22.Kauai (rate = .005)                                                              .00                                                             .00                     .00                  22
 PART V — SCHEDULE  OF ASSIGNMENT OF TAXES BY DISTRICT (ALL taxpayers MUST complete this Part and may be subject to a 10% penalty for noncompliance.)  
 DARKEN the oval of the taxation district in which you have conducted business. IF you did business in MORE THAN ONE district, darken the oval “MULTI” and attach Form G-75.
 23.                    Oahu                               Maui                                Hawaii                                       Kauai            MULTI                                23
                                                                                                                                                              
 PART VI - TOTAL RETURN AND RECONCILIATIONTAXABLE INCOME                                                                                    TAX RATE               TOTAL TAX 
                                                                                                Column c                                    Column d         Column e = Column c X Column d
                                                                                                                                                                                               Neg
 24.  Enter the amount from Part I, line 7 ...................                                                                              x .005   24. 
                                                                                                             .00
                                                                                                                                                                                               Neg
 25. Enter the amount from Part II, line 17 ................                                                                                x .04    25. 
                                                                                                             .00
                                                                                                                                                                                               Neg
 26. Enter the amount from Part III line 18, Column c .............                                                                         x .0015  26. 
                                                                                                             .00
                                                                                                                                                                                               Neg
 27. COUNTY SURCHARGE TAX. See Instructions for Part IV. Multi district complete Form G-75 ....27.                                                       
 28. TOTAL TAXES DUE. Add column e of lines 24 through 27 and enter result here (but not less than zero).                                                                                      Neg
     If you did not have any activity for the period, enter “0.00” here ..............................................28. 
                                                                                       PENALTY  $                
                                                                                     INTEREST  $                                                    
 29.  Amounts Assessed During the Period.......................                                                                                      29.  
                                                                                                                                                                                               Neg
 30. TOTAL AMOUNT.  Add lines 28 and 29. ...................................................................................30. 

 31. TOTAL PAYMENTS MADE         LESS ANY REFUNDS RECEIVED FOR THE TAX YEAR  ..................                                                      31. 

 32.  CREDIT CLAIMED ON ORIGINAL ANNUAL RETURN. (For Amended Return ONLY) ...................32. 

 33.  NET PAYMENTS MADE.  Line 31 minus line 32 ..............................................................................33. 

 34. CREDIT TO BE REFUNDED.            Line 33 minus line 30 ......................................................................                  34. 

 35. ADDITIONAL TAXES DUE.        Line 30 minus line 33 .........................................................................                    35. 
                                                                                     PENALTY  $                 
 36. FOR          LATE FILING               ONLY                                    INTEREST  $                                                     36.  
                                                                                                                                                    
 37. TOTAL AMOUNT DUE AND PAYABLE                              (Add lines 35 and 36) .......................................................         37. 
 38. PLEASE ENTER THE        AMOUNT OF YOUR PAYMENT.   If you are NOT submitting a  
     payment with this return, please enter “0.00” here.  .........................................................................38. 
 39.  GRAND TOTAL OF EXEMPTIONS/DEDUCTIONS CLAIMED. (Attach Schedule GE)  If Schedule  
     GE is not attached, exemptions/deductions claimed will be disallowed. ..........................................39.                                                     .00
 G492H7V9                                                                                                                                                           FORM G-49                      
                                                                                                                                                                    (REV. 2023)                16