Enlarge image
Clear Form
STATE OF HAWAII __ DEPARTMENT OF TAXATION Copy A - For State of Hawaii, Department of Taxation
FORM Application for Withholding Certificate
N-288B for Dispositions by Nonresident
(REV. 2019) Persons of Hawaii Real Property
Interest
• File Copies A and B of this form with the Department of Taxation.
• DO NOT file Form N-288B if the transfer of property has already
taken place. The Department of Taxation will not approve Form
N-288B after the date of transfer reported on line 4a has passed.
• Please be sure to complete ALL lines and attach ALL supporting
documentation OR your application will be rejected.
• See Instructions on the back of Copy B.
1 Name of applicant (Transferor/seller) Identification number (SSN or FEIN)
Mailing address where you want withholding certificate sent Daytime phone no. of applicant
( )
City, State, and ZIP code (province, postal code, and country)
2 Names of all transferors/sellers (Attach additional sheets if more than one transferor/seller.) Identification number (SSN or FEIN)
Address (number and street)
City, State, and ZIP code (province, postal code, and country)
3 Names of all transferees/buyers (Attach additional sheets if more than one transferee/buyer.) I.D. no. (Last 4 numbers of the SSN or FEIN)
Address (number and street)
City, State, and ZIP code (province, postal code, and country)
4 Description of Hawaii real property transaction:
a Date of transfer (month, day, year). DO NOT file Form N-288B if the transfer of property has already taken place.
The Department of Taxation will not approve Form N-288B after the date of transfer has passed.
b Location and general description of property (Include tax map key number) ________________________________________________________
____________________________________________________________________________________________________________________
5 Check the box to indicate the reason a withholding certificate should be issued.
NOTE: The transferor/seller is required under section 235-92, HRS, to file an income tax return whether or not the person derives a taxable gain.
a The transferor/seller will not realize any gain with respect to the transfer. (Complete 5a on the back of Copy A.)
b There will be insufficient proceeds to pay the withholding required under section 235-68(b), Hawaii Revised Statutes, after payment of
all costs, including selling expenses and the amount of any mortgage or lien secured by the property. (Complete 5b on the back of Copy A.)
6 Was the property used at anytime as a rental? ................................. Yes
No
Hawaii Tax I.D. Number
If yes, enter your Hawaii Tax I.D. Number. GE - - -
I hereby declare under penalties provided by section 231-36, HRS, that I have examined this application and accompanying attachments, and, to the best of my knowledge and
Please belief, they are true, correct, and complete.
h ___________________________________________ _______________________________ _________________________
Sign Signature Title (If applicable) Date
h ___________________________________________ _______________________________ _________________________
Here Spouse’s signature (If applicable) Title (If applicable) Date
FOR OFFICIAL USE ONLY:
Approved: Disapproved:
Month Day Year Month Day Year
Amount required to be withheld $
Signature
N288B_I 2019A 01 VID01 ID NO 01 FORM N-288B
