Clear Form

FORM                                                                                      STATE OF HAWAII — DEPARTMENT OF TAXATION 
                                                                    APPLICATION FOR TENTATIVE REFUND FROM CARRYBACK 
N-109 
(REV. 2023)                                                                                               OF NET OPERATING LOSS 
                                                Do Not Attach to Your Income Tax Return — File Separately to Expedite Processing 
                                                                                          For use by individuals, estates, or trusts. 
                                                (NOTE: References to “married” and “spouse” are also references to “in a civil union” and “civil union partner,” respectively.)
                                                CAUTION:            Nonresidents and part-year residents (Form N-15 filers) cannot file this form. See Instructions.  

                                        Name(s)                                                                                                         Federal Employer I.D. No. if any

                                        Address (number and street)                                                                                     Your social security number

                                        City or town, State and Postal/ZIP code                                                                         Spouse’s social security number
                    Please Type or Print
 1   Return for year of net operating loss                                                            (a) Tax year ended        (b) Date filed          2 Amount of net operating loss (see Instructions) 
                                                                                                                                                        $_______________________________
 CAUTION: For net operating losses arising in tax years                                              3  (a) Preceding tax year(s) affected by carryback (b) Did spouse file a separate return?
                                        ending after December 31, 2017, only farming net                  2nd                                            Yes                                    No
                                        operating losses may be carried back 2 years .                    1st                                            Yes                                    No
 4   If you changed your accounting period, give date permission to change was granted 
 5   Have you filed a petition in the Tax Appeal Court for the year or years to which the loss is to be applied?                                         .  .  .  .  .  .  .  .  .  .  .  .  Yes  No
                                                                                                     2nd preceding tax year ended              1st preceding tax year ended              
   Computation of Decrease in Tax                                                                         (a) Before            (b) After               (c) Before                              (d) After 
                                                                                                          carryback             carryback               carryback                            carryback
 6   Adjusted gross income as last determined  . . . . . . . . .  .
 7   Net operating loss deduction resulting from  
                                        carryback (attach computation) (see Instructions)  . . . .  .
 8   Line 6 minus line 7  . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
 9   Deductions (see Instructions)  . . . . . . . . . . . . . . . . . . .  .
 10  Line 8 minus line 9  . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
 11  Exemptions  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
 12  Taxable income (line 10 minus line 11)  . . . . . . . . . . . .  .
 13  Income tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
 14  Refundable tax credits  . . . . . . . . . . . . . . . . . . . . . . . . .  .
 15  Line 13 minus line 14  . . . . . . . . . . . . . . . . . . . . . . . . . .  .
 16  Nonrefundable tax credits (see Instructions)  . . . . . . . .  .
 17  Total tax liability (line 15 minus line 16)  . . . . . . . . . . . .  .
                                                                                column (b)
 18  Enter amount from line 17  . . . . . . . . .                   {           column (d)
 19  Decrease in tax, line 17 minus line 18  . . . . . . . . . . . . .  .

ATTACH A COPY OF YOUR ORIGINAL FEDERAL RETURN FOR THE LOSS YEAR (See Instructions.)
                                                                                                                     Declaration
I declare, under  the penalties  set forth in section 231-36,  HRS, that I have examined  this application,  including  any accompanying  schedules and 
statements, and, to the best of my knowledge and belief, it is true, correct, and complete.

Your signature                                                                                       Date                Spouse’s signature (If joint return, both must sign)               Date

                                                                                                                                                                   FORM N-109 (REV. 2023)

N109_I 2023A 01 VID01                                                                                         ID NO 01

FORM N-109 
(REV. 2023)
Schedule A (Form N-109)—Computation of Net Operating Loss
 1   Adjusted gross income from Form N-11 or N-15 (estates and trusts, start on line 3)  . . . . . . . . . . . . . . . . . . . . . . . . .  .                                    1
 2   Deductions (applies to individuals only):
     a  Enter the amount of your total itemized deductions OR  
        standard deduction from Form N-11 or N-15 (Form N-15 filers, see Instructions)  . .  .                                           2a
     b  Exemptions from Form N-11 or N-15  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .                    2b
     c  Add lines 2a and 2b  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  2c (   )
 3   Combine lines 1 and 2c (estates and trusts, enter your taxable income)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .                              3
     Note:  If line 3 is zero or more, do not complete the rest of the schedule.  You do not have a net operating loss.
Adjustments:
 4   Exemptions from line 2b above (estates and trusts, enter exemption from  
     your tax return)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  4
 5  a   Enter the excess of your nonbusiness capital losses  
        over your nonbusiness capital gains  . . . . . . . . . . . .  .                5a
     b  Enter the excess of your business capital losses  
        over your business capital gains plus nonbusiness  
        capital gains not used in figuring line 8c   . . . . . . . . .  .              5b
     c  Enter total of lines 5a and 5b but not more than your capital loss limitation  . . . . . .  .                                    5c
 6 a    Enter the amount of interest income from Hawaii or  
        any of the Hawaii counties’ obligations   . . . . . . . . . .  .               6a
     b  Enter the amount of interest expense related to  
        income not taxable by Hawaii   . . . . . . . . . . . . . . . . .  .            6b
     c  Line 6a minus line 6b  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .        6c
 7   Net operating loss deduction from other years  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .                     7
 8 a    Nonbusiness deductions (attach supporting documentation)  . .  .               8a
     b  Nonbusiness income plus the excess of your  
        nonbusiness capital gains over your nonbusiness  
        capital losses  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 8b
     c  Line 8a minus line 8b.  If 8b is more than 8a, enter zero  . . . . . . . . . . . . . . . . . . . . .  .                          8c
 9   Add lines 4, 5c, 6c, 7 and 8c  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .   9
 10  Combine lines 3 and 9.  This is your net operating loss.  (see Instructions)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       10
     Caution:  If the amount entered on line 10 is zero or more, you do not have a net operating loss.
          Instructions for Schedule A (Form N-109) — Computation of Net Operating Loss
   Use  this  schedule  to  figure  your  net  op-     capital loss limitation .  For more information, see                                Losses  on  stock  in  small  business  corpora-
erating loss (NOL) that is available for carry-        federal regulations section 1 .172-3 .                                              tions which qualify as ordinary losses are busi-
back (farming NOL only) or carryforward.                Line  8a and  b.—Nonbusiness  income and                                           ness losses .
   Note:  If  you  are  a  nonresident  or  part-year  deductions are those not connected with a trade                                     Shareholders  of an electing small business 
resident (Form N-15 filer), you cannot file Form       or business . For example:                                                          corporation  (S  Corporation)  see  Internal  Rev-
N-109 . However, you may use this schedule to           Your standard deduction is a nonbusiness                                           enue  Code section 1366,  for tax treatment of 
figure  your  NOL  that  is  available  for  carryback deduction .                                                                         pass-thru items to shareholders .
or carryforward. You will need to figure two NOL        Itemized  deductions,  if  elected,  are  usually                                  Loss resulting from the sale or exchange of 
amounts: (1) Your Total NOL (using amounts from        nonbusiness, except for state income taxes re-                                      small business investment company stock, which 
Form N-15, Column A), and (2) Your  Hawaii NOL         lated to a trade or business,  casualty loss de-                                    qualifies as an ordinary loss, is considered as a 
(using amounts from Form N-15, Column B) .             ductions, and any employee business expenses                                        loss attributable to your trade or business .
   Line  1.—Individuals,  enter  your  adjusted        such as union dues, uniforms, tools and educa-                                      The deduction allowed for payment made by 
gross income .                                         tional expenses .                                                                   a self-employed  person  to a retirement plan  is 
   Line  2a.—Individuals,  enter  your  itemized        Salaries and wages you received are trade or                                       treated as a nonbusiness deduction .
deductions, after any limitations, or standard de-     business income .                                                                   Note: Nonbusiness income does not include 
duction .                                               Gain  or loss on  sale  or other disposition  of                                   pensions, social security benefits, and other in-
Form N-15 filers who itemized deductions: When         real or depreciable property used in your trade or                                  come that is exempt from Hawaii income tax .
computing  your  Total NOL, enter your total           business is considered business income or loss .                                    Line 10.—If you are carrying back your farm-
itemized deductions calculated as if you were a         Rental income or loss is business income or                                        ing NOL, enter on page 1, line 2, the lesser of 
full-year resident . When computing your Hawaii        loss .                                                                              (1) the amount which would be the NOL for the 
NOL, enter your Hawaii itemized deductions from                                                                                            taxable year if only income and deductions at-
Form N-15 .                                             Loss on the sale of accounts receivable, if 
                                                       such accounts arose under the accrual method                                        tributable  to  farming  businesses  are  taken  into 
   Line  2b.—Individuals,  enter  the  amount  of      of accounting in your business, is included as a                                    account, or (2) the amount of the NOL on line 10 .
your personal exemptions .                             business deduction .                                                                Form N-15 filers, do not enter an amount on 
   Line 5.—If your business capital gains plus          Casualty losses and theft losses are consid-                                       page 1, line 2. You must file an amended return 
your nonbusiness capital gains not used in figur-      ered attributable to your trade or business .  This                                 on Form N-15 to carry back your NOL.
ing line 8c exceed your business capital  losses,      is true even if it involves nonbusiness property .
enter zero on line 5b.  If you have a net capital 
loss for the year, do not include in line 5c your net   Your proportionate  share of a partnership’s 
capital loss not allowed this year because of the      income or loss is considered  business income 
                                                       or loss .
Page 2

FORM N-109 
(REV. 2023)
                                                          STATE OF HAWAII — DEPARTMENT OF TAXATION 
                 GENERAL INSTRUCTIONS FOR APPLICATION FOR TENTATIVE 
                 REFUND FROM CARRYBACK OF NET OPERATING LOSS (NOL) 
                                                                               
                               FOR USE BY INDIVIDUALS, ESTATES, OR TRUSTS 
                                                                               
                               (Section references are to the Internal Revenue Code unless otherwise specified)
A. WHO MAY FILE AN APPLICATION.—An                           B.  TIME  AND PLACE FOR  FILING.—This                 sion of time granted) for filing the return for the 
application for a tentative carryback adjustment          form must be filed with the Hawaii  Department           taxable year of the NOL from which the carryback 
may  be  filed  by  any  individual,  estate,  trust,  or of Taxation at P.O. Box 3559, Honolulu, Hawaii           results.
fiduciary  who  desires  a  quick  refund  of  taxes      96811-3559,  and  must  be  filed  on  or  after  the    E. DISALLOWANCE  OF  APPLICATION.—
which  are  affected  by  the  carryback  of  a  farm-    date of filing of the return for the taxable year of     Any  application  which  contains  material  omis-
ing NOL.                                                  the NOL and within 12 months from the end of             sions or computation errors which the Director of 
A “farming loss” means the lesser of (1) the              such taxable year.  Do not attach this form to your      Taxation deems cannot be corrected within the 
amount which would be the NOL for the taxable             income tax return.                                       90-day period may be disallowed.  This applica-
year if only income and deductions attributable           Note:  If you fail to meet the foregoing limitation,     tion for a tentative carryback adjustment does not 
to farming businesses are taken into account, or          you  may  file  an  amended  return  within  three       constitute a claim for credit or refund.  If this ap-
(2) the amount of the NOL for such taxable year.          years  of  the  due  date  prescribed  for  filing  the  plication is disallowed in whole or in part, no suit 
Note:  NOLs  are  limited  by  IRC  section  461(l),      return, including extensions, for the NOL year or        based thereon may be maintained in any court 
so the NOL carryback generally will not exceed            the period agreed to  under a written extension of       for the recovery of the tax.  The taxpayer may, 
$250,000  ($500,000  for  joint  returns).  See  the      time, whichever is later.                                however, file a regular claim for credit or refund 
Instructions for federal Form 461, Limitation on             C. RECOMPUTATION OF TAX LIABILITY.—                   on an amended return at any time before the ex-
Business Losses.                                          To  arrive  at  the  decrease  in  the  tax  previously  piration of the applicable period of limitation, as 
Note: If  you are a nonresident  or part-year             determined,  recompute  the  tax  after  taking  the     further explained in Item G.
resident (Form N-15 filer), you cannot file Form          carryback(s)  into  account.  Form  N-11  or  N-40       F.  EXCESS ALLOWANCES.—Any amount 
N-109. However, you may use Schedule A (Form              and  instructions  for  the  applicable  year  will  be  applied,  credited,  or  refunded  on  the  basis  of 
N-109)  to  figure  your  NOL  that  is  available  for   helpful in making this recomputation.                    this application which is later determined by the 
carryback  or  carryforward.  You  must  file  an            Figure  the  amount  of  decrease,  attributable      Department of Taxation to be excessive may be 
amended return on Form N-15 to carry back your            to the carryback, in tax previously determined for       assessed as a deficiency as if it were due to a 
farming NOL. See Item G, Amended Return, for              each tax year before the tax year of the NOL. The        mathematical or clerical error appearing on the 
information on filing an amended return.                  tax previously determined will be the tax shown          return.
A taxpayer has an option on whether or not to             on the return as filed, increased by any amounts         G. AMENDED RETURN.—An individual, es-
carry a farming loss back first before carrying it        assessed  (or  collected  without  assessment)  as       tate,  trust,  or  fiduciary  may  obtain  a  refund  by 
forward.  This form should only be used by those          deficiencies before the date of the filing of the ap-    filing  an  amended  return. A  separate  amended 
taxpayers choosing to carry their farming losses          plication, and decreased by any amounts abated,          return must be filed for each year that a refund is 
back.                                                     credited,  refunded,  or  otherwise  repaid  prior  to   requested. Generally, the amended return must 
Election  Not  to  Carryback. You may  elect              that date.                                               be filed within 3 years after the due date of the 
to carry the farming NOL forward instead of first            After figuring the tax previously determined,         return for the tax year of the NOL.
carrying it back to prior years. If you make this         figure the decrease in tax previously determined         If  you  are  an  individual,  fill  in  the  amended 
election, then you can use your farming NOL only          attributable to the carryback and any related ad-        return oval and the NOL Carryback oval at the 
in the carryforward period.                               justments on the basis of the items of tax taken         top of Form N-11 or Form N-15. Complete your 
To make this election, attach a statement to              into account in computing the tax previously de-         amended return with all of the correct information. 
your original return filed by the due date (includ-       termined.  In determining  any decrease  attribut-       Attach Schedule AMD, Explanation of Changes 
ing  extensions)  for  the  farming  NOL  year. This      able to the carryback or any related adjustment,         on Amended  Return,  to  the  income  tax  return. 
statement  must  state  that  you  are  electing  to      items must be taken into account only to the ex-         Also attach all forms and statements required to 
waive  the  carryback  period  under  section  235-       tent that they were reported on the return, or were      file a complete return. If you are claiming any tax 
7(d), HRS, and IRC section 172(b)(1)(B)(iv).              reflected in amounts assessed (or collected with-        credits, remember to attach the required forms, 
                                                          out assessment) as deficiencies, or in amounts           such as Schedule CR and Schedule X, even if 
If  you  filed  your  original  return  on  time  but     abated, credited, refunded, or otherwise repaid,         you claimed the credits on the original return. A 
did not file the statement with it, you can make          before the date of filing the application.               copy of your original federal income tax return for 
this  election  on  an  amended  return  filed  within                                                             the loss year must also be attached.
6 months of the original due date of the return,             Deductions  (except  the  charitable  contribu-
but not including any extension. Attach a state-          tions deduction) which are limited, for example,         H.  YEARS TO WHICH  YOU MAY CARRY 
ment  to  your  amended  return,  and  write  “Filed      by taxable income or adjusted gross income, are          AN NOL.— For NOLs arising in tax years end-
pursuant to 26 C.F.R. 301.9100-2” at the top of           to be recomputed after carryback of the NOL.             ing  after  December  31,  2017,  NOL  carrybacks 
the statement. Also include the statement noted              If the amount of any tax for any taxable year is      are  eliminated  (except  for  farming  NOLs  which 
above that you are waiving the carryback period.          unpaid, including any installment not yet due, at        are permitted a two-year carryback), and unused 
Once you elect to waive the carryback period,             the date of filing the application, enter the unpaid     NOLs may be carried forward indefinitely.
it cannot be changed later.                               amount of such tax in the appropriate column.            Any amount of the loss not used to offset 80% 
If you do not file this statement on time, the            Note:   As provided  by statute, adjustment  to          of the taxable income (adjusted, as explained in 
carryback period cannot be waived and you must            refundable tax credits, except the credit for child      Item K) for the second preceding year is carried 
first carry the farming NOL back before carrying          and dependent care expenses, must be claimed             to the first preceding year.  Where the loss is not 
it forward.                                               on  or  before  the  end  of  the  year  following  the  entirely used to offset 80% of the taxable income 
                                                          year for which the credits are claimed.                  (adjusted) in the 2 preceding years, the balance 
However, no part of any farming NOL incurred                                                                       may be carried forward indefinitely.
outside of the State prior to beginning business in          D.  ALLOWANCE OF ADJUSTMENT.—The                      Note: For tax years beginning after Decem-
the State may be included in such election.               Director  of  Taxation  will  act  on  this  application ber 31, 2017, and before January 1, 2026, Act 
Change in Filing Status. Special rules apply              within  90  days  from  whichever  of  the  following    27,  Session  Laws  of  Hawaii  2018,  limits  the 
if you filed a joint return (or a separate return) for    two dates is later:                                      amount of losses from the trades or businesses 
some but not all of the tax years involved in figur-         1.  The date on which this application is filed;      of noncorporate taxpayers that the taxpayer can 
ing an NOL  carryback. For details, see federal           or                                                       claim each year. Taxpayers can’t deduct losses 
Publication  536. Attach  a  computation  showing            2.  The last day of the month in which falls the      in  excess  of  a  threshold  amount  in  the  current 
how you figured the carryback.                            last date prescribed by law (including any exten-        year. The amount of the excess business loss is 
Page 3

FORM N-109 
(REV. 2023)
treated as an NOL carryover to later tax years.           (3)  Your  taxable  income  for  the  prior  tax       Line 7. Net operating loss deduction re-
Use federal Form 461 to figure the excess busi-           year(s)  is  determined  without  taking  into  ac-    sulting from carryback. — Your NOL deduction 
ness loss.                                                count the NOL carryback from the loss year or          is limited to 80% of taxable income.
I.  NOL DEDUCTION.—The sum of your NOL                    any later tax year.  NOLs, otherwise allowable as      Line 9. Deductions. — Individuals — Enter 
carrybacks  and  carryovers  is  your  NOL  deduc-        carrybacks or carryovers, occurring in tax years       the amount of your itemized deductions, after any 
tion for the tax year to which carried.  Before you       before such loss year, are taken into account in       limitations, or the standard deduction amount if 
can figure your NOL deduction for the year, you           figuring the taxable income for the prior tax year.    you did not itemize your deductions.
must first determine what part of any NOLs for            (4) You may not claim any personal exemp-              If  your  Hawaii  adjusted  gross  income  was 
any  earlier  or  later  tax  years  represents  carry-   tions.                                                 more  than  $83,400,  and  you  were  not  able  to 
overs or carrybacks to the tax year under con-            (5) Any deductions claimed, except charitable          deduct all of your itemized deductions, enter the 
sideration.  When you have more than one NOL              contributions,  which  are  based  on  or  limited  to amount you were able to deduct as calculated on 
to be carried to the same tax year, apply the loss        a percentage of adjusted gross income (such as         the Total Itemized Deductions Worksheet in your 
from the earliest year first.                             medical expenses) must be refigured on the ba-         Form N-11 instruction booklet.
J.  COMPUTATION  WHEN THE  NOL IS                         sis of the adjusted gross income after application     The standard deduction amounts are $2,200 
FULLY  ABSORBED IN THE EARLIEST  PRE-                     of adjustments (1), (2), and (3) above.  The de-       for  single  or  married  filing  separately  filers; 
CEDING  TAX YEAR.—In  refiguring  your  tax  li-          duction for charitable contributions is determined     $3,212 for head of household filers; and $4,400 
ability  for  the  year  to  which  the  NOL  is  carried using the same adjustments except that you do          for married filing jointly or qualifying widow(er) fil-
and fully absorbed, the deduction for charitable          not  take  into  account  any  NOLs  being  carried    ers.
contributions is determined without regard to any         back.                                                  Line 11. Exemptions. — Individuals — Enter 
NOL carryback.  Any other deductions claimed,             The taxable income as modified is to be con-           $1,144 times the number of exemptions claimed. 
based on or limited to a percentage of your ad-           sidered not less than zero.                            Those  qualifying  for  the  disability  exemp-
justed gross income (such as medical expenses)            L. ATTACHMENTS.—Attach a copy of your                  tion use the appropriate amounts instead of the 
must be refigured on the basis of your adjusted           original  federal  income  tax  return  for  the  loss above.
gross income, determined after application of the         year to Form N-109. If a copy of your federal re-      Line 13. Income Tax. — Refigure your tax af-
NOL carryback.  Also, any credits based on or             turn is not attached, the processing of your return    ter the carryback to determine the tax decrease.  
limited by the tax may be figured on the tax li-          and refund may be delayed.                             Include  in  the  tax  before  carryback,  amounts 
ability as determined after application of the NOL 
                                                                                                                 shown on your original or amended return, and 
carryback.                                                Line-By-Line Instructions For                          later adjusted, based on an examination of your 
K.  COMPUTATION  WHEN THE  NOL  IS 
NOT FULLY ABSORBED IN PRECEDING TAX                       Form N-109                                             return.
YEAR(S).—The  amount  of  an  NOL  which  you             Enter in columns (a) and (c), your tax for the         Attach a detailed computation of the new tax 
may carry to the next year, after applying it to a        applicable carryback year as shown on your orig-       liability  shown  on  line  13,  columns  (b)  and  (d).  
prior year or years, is the excess, if any, of the        inal or amended return.  If the return was exam-       The tax form and instructions for the applicable 
NOL carryback over 80% of the taxable income              ined, enter the amounts that were determined as        year will be helpful in making this computation.  
of  such  prior  year(s)  figured  with  the  following   a result of the examination.                           Include  in  the  amount  on  line  13  any  tax  from 
modifications:                                            Line  2. Amount of net operating  loss. —              Forms N-2, N-103, N-152, N-312, N-325, N-338, 
(1) Your deduction for capital losses must not            Enter the lesser of (1) the amount which would         N-344, N-348, N-405, N-586, or N-814.
be more than the capital gains included in gross          be the NOL for the taxable year if only income         Line 16. Nonrefundable tax credits. — En-
income.                                                   and deductions attributable to farming business-       ter the total of your nonrefundable tax credits. Do 
                                                          es are taken into account, or (2) the amount of        not enter an amount that is more than the amount 
(2) You are not permitted any deduction for               the NOL on page 2, Schedule A, line 10.                of your adjusted income tax liability on line 15. If 
the excess of a net long-term capital gain over a 
net short-term capital loss.                                                                                     line 15 is zero or less, enter zero on line 16.

Page 4