Clear Form
                                                                                                                
SCHEDULE PTE                               STATE OF HAWAII — DEPARTMENT OF TAXATION                                                                                             TAX YEAR
(2023)
                                               PASS-THROUGH ENTITY 
                                                                                                                                                                                20__ 
                                                           TAX CALCULATION
                                               † Attach to Form N-20 or Form N-35
SCHPTE_I 2023A 01 VID01
Check    if:     Supplement to Part II Only
Name as shown on tax return                                                                                                Federal Employer I.D. No. (FEIN)

  Part      I  ELECTIVE TAX INFORMATION

1.  Total number of all qualified members .......................................................................................................................             1

2.  Total qualified net income for all qualified members ..................................................................................................                   2
3.  Elective Tax Rate ....................................................................................................................................................... 3      11.00%
4.  Multiply line 2 by line 3 (if less than zero, enter zero). This is the total amount of elective tax.  
    Enter the result here and on Form N-20, line 17a or Form N-35, line 22f.  ...............................................................                                 4
 Part       II SCHEDULE OF QUALIFIED MEMBERS

1.  Total number of qualified members reported on this form .........................................................................................                         1
2.  Total qualified net income for all qualified members reported on this form  
    (combine all box   amountsa from below and page 2)           ................................................................................................             2
3.  Total elective tax credit amount for all qualified members reported on this form  
    (combine all box   amountsb from below and page 2)           ...............................................................................................              3
            Qualified Member Name                                                                                          FEIN
                                                                                                                           SSN
   A
            a.  Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ...............                                                a
            b.  Elective tax credit amount (Multiply box   by 11.00%a and enter the result. If less than zero, enter zero)  ....                                              b
            Qualified Member Name                                                                                          FEIN
                                                                                                                           SSN
   B
            a.  Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ...............                                                a
            b.  Elective tax credit amount (Multiply box   by 11.00%a and enter the result. If less than zero, enter zero)  ....                                              b
            Qualified Member Name                                                                                          FEIN
                                                                                                                           SSN
   C
            a.  Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ...............                                                a
            b.  Elective tax credit amount (Multiply box   by 11.00%a and enter the result. If less than zero, enter zero)  ....                                              b
            Qualified Member Name                                                                                          FEIN
                                                                                                                           SSN
   D
            a.  Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ...............                                                a
            b.  Elective tax credit amount (Multiply box   by 11.00%a and enter the result. If less than zero, enter zero)  ....                                              b
            Qualified Member Name                                                                                          FEIN
                                                                                                                           SSN
   E
            a.  Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ...............                                                a
            b.  Elective tax credit amount (Multiply box   by 11.00%a and enter the result. If less than zero, enter zero)  ....                                              b
            Qualified Member Name                                                                                          FEIN
                                                                                                                           SSN
   F
            a.  Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ...............                                                a
            b.  Elective tax credit amount (Multiply box   by 11.00%a and enter the result. If less than zero, enter zero)  ....                                              b
PTE1H7V9                                                              ID NO 01                                                                                                SCHEDULE PTE (2023)

SCHEDULE PTE                                                                                                             Page 2
(2023)

SCHPTE_I 2023A 02 VID01
Name as shown on tax return                                                                                  Federal Employer I.D. No. (FEIN)

 Part II SCHEDULE OF QUALIFIED MEMBERS - continued
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 G
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 H
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 I
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 J
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 K
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 L
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 M
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 N
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
      Qualified Member Name                                                                                  FEIN
                                                                                                             SSN
 O
      a. Sum of pro-rata or distributive share and guaranteed payments included in qualified net income ............... a
      b. Elective tax credit amount (Multiply box  aby 11.00% and enter the result. If less than zero, enter zero) .... b
PTE2H7V9                                               ID NO 01                                                         SCHEDULE PTE (2023)