FORM STATE OF HAWAII — DEPARTMENT OF TAXATION DO NOT WRITE IN THIS AREA

(Rev.N-112023) Individual Income Tax Return
 RESIDENT
  Calendar Year 2023
OR
M M     D D     Y Y                      M M    D D     Y Y
N11_I 2023A 01 VID01 Fiscal Year  and
Beginning  Ending

AMENDED Return FOR OFFICE USE ONLY
NOL Carryback
IRS Adjustment                     THIS 
First Time Filer

Please Write Using a Black Ink Pen. SPACE  
Enter One Letter Or Number In Each Box. 
Fill In Ovals Completely.  Do NOT Submit a Photocopy!!
RESERVED

Your First Name M.I. Your Last Name Suffix
u IMPORTANT — Complete this Section u
 
Spouse’s First Name M.I. Spouse’s Last Name Suffix Enter the first four letters  
of your last name. 
Use ALL CAPITAL letters 
Your Social 
Care Of (See Instructions, page 7.) Security Number

Deceased  Date of Death
Present mailing or home address (Number and street, including Rural Route)   M M        D D       Y Y  
Enter the first four letters  
of your Spouse’s last name.  
Use ALL CAPITAL letters
City, town or post office State Postal/ZIP code Spouse's Social 
Security Number
• ATTACH COPY 2 OF FORM W-2 HERE •
 
 If Foreign address, enter Province and/or State  Country Deceased  Date of Death
 
  M M        D D       Y Y  
 
  (Fill in only ONE oval)
  1   Single    4  Head of household (with qualifying person).  If the qualifying 
 2    Married filing joint return (even if only one had income). person is a child but not your dependent, enter the child’s full 
 3    Married filing separate return.  Enter spouse’s SSN and name.
the first four letters of last name above. Enter spouse’s full  †
 __________________________________
name here.  _____________________________________    5  Qualifying surviving spouse (see page 8 of the Instructions) 
CAUTION: If you can be claimed as a dependent on another person’s tax return (such as your parents’), DO NOT fill in oval 6a, but be sure to fill in the oval above line 21.
 6a     Yourself .............................................     Age 65 or over ........................................................ Enter the number of ovals 
   6b     Spouse .............................................     Age 65 or over ........................................................} filled on 6a and 6b ......... Â 
 
   If you filled ovals 3 and 6b above, see the Instructions on page 9 and if your spouse meets the qualifications, fill in this oval
 6c Dependents: If more than 6 dependents   2. Dependent’s social
 and 1. First and last name use attachment  security number 3. Relationship

6d Enter number of 
your children listed... 6c  Â
Enter number of 
• ATTACH CHECK OR MONEY ORDER HERE • other dependents.....6d  Â

 6e Total number of exemptions claimed.  Add numbers entered in boxes 6a thru 6d above .............................................. 6e Â

N111E3T4 ID NO 01 FORM N-11 (REV. 2023)

Form N-11 (Rev. 2023)                                                                                                                                       Page 2 of 4
                                                    Your Social Security Number                  Your Spouse’s SSN

                                                 Name(s) as shown on return
N11_I 2023A 02 VID01                                                                        ___________________________________________________

 If amount is negative (loss), shade the minus (-) in the box.  Example:                          -
                                                                                                                                                     ROUND TO THE NEAREST DOLLAR

 7  Federal adjusted gross income (AGI) (see page 11 of the Instructions) .......................................                                 7  -                              .00
 8  Difference in state/federal wages due to COLA, ERS,  
      etc. (see page 11 of the Instructions) ...................................8
 9  Interest on out-of-state bonds                                                                                                .00
      (including municipal bonds) ..................................................9
 10  Other Hawaii additions to federal AGI                                                                                        .00
      (see page 11 of the Instructions) ........................................10
                                                                                                                                  .00
 11  Add lines 8 through 10 ..................   Total Hawaii additions to federal AGI             11
                                                                                                                                                         .00

 12  Add lines 7 and 11 ......................................................................................................................... 12 -                              .00
 13  Pensions taxed federally but not taxed by Hawaii
      (see page 13 of the Instructions) ........................................13
                                                                                                                                  .00
 14  Social security benefits taxed on federal return .................14
 15  First $7,683 of military reserve or Hawaii national                                                                          .00
      guard duty pay ....................................................................15
                                                                                                                                  .00
 16  Payments to an individual housing account .......................16
 17  Exceptional trees deduction (attach affidavit)                                                                               .00
      (see page 14 of the Instructions) ........................................17
 18  Other Hawaii subtractions from federal AGI                                                                                   .00
      (see page 14 of the Instructions) ........................................18
 19  Add lines 13 through 18                                                                                                      .00
     ............................................Total Hawaii subtractions from federal AGI        19
                                                                                                                                                         .00

 20  Line 12 minus line 19 ............................................................................................ Hawaii AGI   †            20 -                              .00
CAUTION: If you can be claimed as a dependent on another person’s return, see the Instructions on page 15, and fill in this oval.
 21  If you do not itemize your deductions, go to line 23 below.  Otherwise go to page 15 of the Instructions 
      and enter your itemized deductions here.
 21a  Medical and dental expenses  
      (from Worksheet A-1) .......................................................21a
                                                                                                                                  .00
                                                                                                                                                         TOTAL ITEMIZED 
 21b  Taxes (from Worksheet A-2) ............................................ 21b
                                                                                                                                  .00                    DEDUCTIONS
                                                                                                                                                       22  Add lines 21a through 21f.  
 21c  Interest expense (from Worksheet A-3) ............................21c                                                                              If your Hawaii adjusted gross 
                                                                                                                                  .00                    income is above a certain 
                                                                                                                                                         amount, you may not be 
 21d  Contributions (from Worksheet A-4) ................................ 21d                                                                            able to deduct all of your 
                                                                                                                                  .00                    itemized deductions. See the 
                                                                                                                                                         Instructions on page 19. Enter 
 21e  Casualty and theft losses (from Worksheet A-5) ..............21e                                                                                   total here and go to line 24.
                                                                                                                                  .00
 21f  Miscellaneous deductions (from Worksheet A-6) ............. 21f
                                                                                                                                  .00                                               .00
 23  If you checked filing status box: 1 or 3 enter $2,200;  
      2 or 5 enter $4,400; 4 enter $3,212 ........................................................Standard Deduction †                            23
                                                                                                                                                                                    .00
    24  Line 20 minus line 22 or 23, whichever applies. (This line MUST be filled in) ..................                                          24 -
                                                                                                                                                                                    .00

N112E3T4                                                     ID NO 01                                                                                    FORM N-11 (REV. 2023)

Form N-11 (Rev. 2023)                                                                                                                             Page 3 of 4
                                                              Your Social Security Number                  Your Spouse’s SSN

                                                Name(s) as shown on return
N11_I 2023A 03 VID01                                                                           ___________________________________________________
 25   Multiply $1,144 by the total number of exemptions claimed on line 6e.  
      If you and/or your spouse are blind, deaf, or disabled, fill in the applicable oval(s),  
      and see page 20 of the Instructions. 
            Yourself              Spouse .................................................................................................. 25
                                                                                                                                                  .00
 26   Taxable Income. Line 24 minus line 25 (but not less than zero) .................. Taxable Income †                                    26
 27   Tax. Fill in oval if from    Tax Table;                 Tax Rate Schedule; or                           Capital Gains Tax                   .00
      Worksheet on page 33 of the Instructions.                                                 
     (          Fill in oval if tax from Forms N-2, N-103, N-152, N-168, N-312, N-338,  
    N-344,   N-348, N-405, N-586, N-615, or N-814 is included.)                    ..............................................Tax †      27
 27a  If tax is from the Capital Gains Tax Worksheet, enter                                                                                       .00
      the net capital gain from line 14 of that worksheet ...........27a
                                                                                                                                     .00

  28  Refundable Food/Excise Tax Credit 
      (attach Form N-311) DHS, etc. exemptions                  ....28
                                                                                                                                     .00
 29  Credit for Low-Income Household  
      Renters (attach Schedule X) ..............................................29
 30  Credit for Child and Dependent                                                                                                  .00
      Care Expenses (attach Schedule X) ..................................30
 31  Credit for Child Passenger Restraint                                                                                            .00
      System(s) (attach a copy of the invoice) ............................31
 32  Total refundable tax credits from                                                                                               .00
      Schedule CR (attach Schedule CR) ...................................32
                                                                                                                                     .00
 33  Add lines 28 through 32 .................................................................Total Refundable Credits †                    33
                                                                                                                                                  .00
 34  Line 27 minus line 33. If line 34 is zero or less, see Instructions. ....... Adjusted Tax Liability †                                  34 -
                                                                                                                                                  .00
 35  Total nonrefundable tax credits (attach Schedule CR) ..................................................................                35
                                                                                                                                                  .00
 36  Line 34 minus line 35 ................................................................................................. Balance †      36 -
 37  Hawaii State Income tax withheld (attach W-2s)                                                                                               .00
       (see page 22 of the Instructions for other attachments) ...................37
                                                                                                                                     .00
 38  2023 estimated tax payments ............................................38
                                                                                                                                     .00
 39  Amount of estimated tax applied from 2022 return ............39
                                                                                                                                     .00
 40  Amount paid with extension ...............................................40
                                                                                                                                     .00
 41  Add lines 37 through 40 .................................................................................Total Payments †              41
                                                                                                                                                  .00

 42  If line 41 is larger than line 36, enter the amount OVERPAID (line 41 minus line 36) (see Instructions) .                              42 
 43   Contributions to (see page 22 of the Instructions): ........................    Yourself   Spouse                                           .00
      43a   Hawaii Schools Repairs and Maintenance Fund .....................                     $2                               $2
      43b   Hawaii Public Libraries Fund ...................................................      $5                               $5
      43c   Domestic and Sexual Violence / Child Abuse and Neglect Funds .............            $5                               $5
 44  Add the amounts of the filled ovals on lines 43a through 43c and enter the total here .................                                44
                                                                                                                                                  .00
         45  Line 42 minus line 44 ........................................................................................................ 45
                                                                                                                                                  .00

N113E3T4                                                       ID NO 01                                                                         FORM N-11 (REV. 2023)

Form N-11 (Rev. 2023)                                                                                                                                                                                                 Page 4 of 4
                                                                                              Your Social Security Number                  Your Spouse’s SSN

                                                                                     Name(s) as shown on return
N11_I 2023A 04 VID01                                                                                                 ___________________________________________________
  46  Amount of line 45 to be applied to your  
                                        2024 ESTIMATED TAX ......................................................46 
   47a  Amount to be REFUNDED TO YOU (line 45 minus line 46) If filing late,                                                                  .00
                       see page 23 of Instructions ...........................................................................................................  47a 
                                                                                                                                                                                                                      .00
                                           Fill in this oval if this refund will ultimately be deposited to a foreign (non-U.S.) bank.  Do not complete lines 47b, 47c, or 47d.
                                         
   47b  Routing number                                                                                     47c  Type:        Checking           Savings

   47d  Account number                                        
 
   48                                   AMOUNT YOU OWE (line 36 minus line 41). ............................................................................... 48 
   49  PAYMENT AMOUNT Submit payment online at hitax.hawaii.gov or attach check or                                                                                                                                    .00
                       money order payable to “Hawaii State Tax Collector.” ..................................................................                  49 
   50                                   Estimated tax penalty.  (See page 23 of                                                                                                                                       .00
                       Instructions.) Do not include on line 42 or 48.  Fill in 
                       this oval if Form N-210 is attached †                               ....................50
                                                                                                                                              .00
  51                                    AMENDED RETURN ONLY –  Amount paid (overpaid) on original return. (See Instructions) (attach Sch. AMD).......           51   -
                                                                                                                                                                                                                      .00
   52                                   AMENDED RETURN ONLY –  Balance due (refund) with amended return. (See Instructions) (attach Sch. AMD) .....             52   -
                                                                                                                                                                                                                      .00

   53  Did you file a federal Schedule C?                                              Yes         No                   If yes, enter Hawaii gross receipts     
                              your main business activity:                                            ,                                                                                                               .00 
                              your main business product:                                             , AND your HI Tax I.D. No. for this activity GE 
   54  Did you file a federal Schedule E                                                                            If yes, enter Hawaii gross rents received     
                              for any rental activity?                                 Yes          No                                                                                                                .00 
                                                                                                        AND your HI Tax I.D. No. for this activity GE
                                                                                                                                                                     
   55  Did you file a federal Schedule F?                                              Yes         No                   If yes, enter Hawaii gross receipts   
                              your main business activity:                                            ,                                                                                                               .00 
                              your main business product:                                             , AND your HI Tax I.D. No. for this activity GE 

                                        If designating another person to discuss this return with the Hawaii Department of Taxation, complete the following. This is not a full power of  
                                        attorney. See page 25 of the Instructions.
                     DESIGNEE           Designee’s name   † †                                                       Phone no.   † †                             Identification number     † †
   HAWAII ELECTION                                                   Indicate if you want $3 to go to the Hawaii Election Campaign Fund.                            Yes       Note: Filling in the “Yes” oval will 
   (SeeCAMPAIGN FUND page 25 of the Instructions)                Â ÂIf joint return, indicate if your spouse designates $3 to the fund.                             Yes       not change your tax or refund.
                                                                 
                                        DECLARATION — I declare, under the penalties set forth in section 231-36, HRS, that this return (including 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 taxable year stated, pursuant to the Hawaii Income Tax Law, Chapter 235, HRS.
                                             Your signature                                           Date                          Spouse’s signature(ifDate                                                                     filing jointly, BOTH must sign) 

                              †                                                                                                †
                                             Your Occupation                                          Daytime Phone Number          Your Spouse’s Occupation                                 Daytime Phone Number

              PLEASE                               Preparer’s                                                                        Date                       Check if                PTIN 
                              SIGN HERE            Signature   ††                                                                                               self-employed    † † o † †
                                        Paid 
                                                   Preparer’s Name  ††                                                                                          Federal E.I. No.  
                                        Preparer’s Print                                                                                                                             † †
                                        Information
                                                   Firm’s name (or yours      ††                                                                                Phone No.  † † 
                                                   if self-employed),         
                                                   Address, and ZIP Code                                                             

N114E3T4                                                                                              ID NO 01                                                                       FORM N-11 (REV. 2023)