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FORM GEW-TA-RV-1              STATE OF HAWAII                                          DO NOT WRITE IN THIS AREA
(REV. 2022)                   DEPARTMENT OF TAXATION                                                             
                                                                                                                                   01
             NOTIFICATION OF CANCELLATION 
                OF TAX LICENSES AND TAX PERMITS

Name

Trade Name or Doing Business As (DBA) Name
(           )
Telephone Number

CANCEL MY TAX ACCOUNT(S) AS INDICATED BELOW:

                              License, Registration,                                                             Effective Date  
      Tax Type                                                          License/Registration/Permit Number
                              or Permit                                                                          (MM/DD/YYYY)

Example:  Cigarette & Tobacco Retail Dealer’s Permit                    TR-123-456-7890-01P                       12/31/2022

Instructions to Cancel Tax Account(s):
Column 1, Tax Type — Enter the tax type for each license, registration or permit that you are cancelling.
Column 2, License, Registration or Permit — Enter the type of account being cancelled. Specify whether the account is a license, a 
registration, or a permit.  
Column 3, License/Registration/Permit Number — Enter the license, registration, or permit number for the account you are cancelling.  
Column 4, Effective Date — Enter the effective date for the cancellation of the license, registration or permit.  The effective date of 
cancellation is the last day of the filing period for the last tax return that is required to be filed, even if no tax is due.  For example, if the 
last required tax return is for the fourth quarter of 2022, the effective date of cancellation would be 12/31/2022 (not 1/1/2023). 
Signature, Filing, & Payment Requirements:  This form must be signed and sent to the Department of Taxation (Department) with the 
tax license(s), registration(s) or permit(s) that you are cancelling.  An unsigned cancellation notice will not be accepted.  All required 
periodic (monthly, quarterly, or semiannual) and annual tax returns must be filed up to the date of cancellation and all taxes due paid in 
full.  If the required returns and taxes due are not filed and paid in full, the tax license(s), registration(s) or permit(s) will be cancelled as 
requested, but your tax account(s) will remain open for actions by the Department to the extent permitted by law.
                                                     Mailing Address: 
                                                     Hawaii Department of Taxation 
                                                     Tax Registration 
                                                                        P. O. Box 1425 
                                                     Honolulu, HI  96806-1425                                     GEWTARV1_I 2022A 01 VID01

Signature of Owner, Partner or Member, Officer, or Duly Authorized Agent

Print Name of Signatory

Title                                 Date

                                                                                            FORM GEW-TA-RV-1 (REV. 2022)  01
                                                     ID NO 01






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