Clear Form

Form                                             State of Hawaii – Department of Taxation
L-110                     Electronic Filing or Payment Exemption Application
(REV. 2021)
                                                                                                                               L110_I 2021A 01 VID01
                Complete this form to request an exemption from the requirement to file electronically or to pay by Electronic 
                Fund Transfer (EFT). An application MUST be submitted at least 30 days prior to the due date of a return or of an EFT.
Taxpayer Information
o FEIN                                           Taxpayer Name                                                      Contact Phone Number
o SSN
Mailing Address                                                                     City                   State          Zip Code

Tax Type – Check only those tax types for which an exemption is requested.
… Cigarette and Tobacco                        … Estate and Transfer              … General Excise         … Rental Motor, Tour, & Car
… Corporate Income                             … Franchise                        … Liquor                          Sharing Vehicles
… Employer’s Withholding                       … Fuel                             … Public Service Company … Transient Accommodations

Reason for Exemption – Check the reason the waiver is being requested and attach any supporting information.
… No access to a device or computer
… No Internet availability
… Other — Explain in detail the specific reason:

                                                                     Declaration
           I declare, under penalties set forth in section 231-36, HRS, that this application (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 application, made in good faith prepared in accordance with 
the provisions of Chapter 231, HRS, and the rules issued thereunder.
           I further understand that if approved, this exemption from electronic filing or EFT requirements is to remain in effect for and including the date 
indicated below OR until I am notified in writing that the State of Hawaii Department of Taxation has withdrawn its approval for the exemption, whichever 
is earlier.

Signature of Taxpayer or Duly Authorized Agent                                                             Date

Printed Name                                                                                       Title

GENERAL INFORMATION                                                               comply with the requirements. Additional supporting documentation may be 
Exemption requests cannot be applied retroactively. Once an exemption             submitted along with the exemption application. Unwillingness, computer 
application  is  received  and  the  review  process  is  completed,  a  copy  of system  failure,  break  in  Internet  coverage  or  failure  to  maintain  Internet 
the approved/denied application will be sent out in approximately ten (10)        access would not be considered good cause for an exemption.
business days from the date of receipt. If approved, the exemption is valid       WHERE TO FILE
for one year from the date of approval; the time period for the exemption will 
be stated on the approved application. Please keep a copy of this approved                 Mail completed application to:
application in your records. Upon the expiration of the exemption period, a 
new exemption application must be submitted outlining the reason(s) why                    State of Hawaii – Department of Taxation
you are unable to comply with the mandate to file electronically or to pay                              Form L-110 Review
by EFT.                                                                                                 P.O. Box 259
REASON FOR EXEMPTION                                                                               Honolulu, HI 96809-0259
You  must  show  a  good  faith  effort  to  comply  with  the  e-file  or  EFT            tax.technical.section@hawaii.gov
requirements before an exemption will be granted. The exemption application                             Ph: 808.587.1577
must include a statement of the specific reason(s) why you are unable to 

             The Department of Taxation may waive the 2% penalty if noncompliance with the mandate to file electronically or to pay by EFT 
                                                      is due to reasonable cause and NOT due to neglect.
                                                                                                                         Form L-110 (REV. 2021)
                                                               ID NO 01