FORM TA-1                                                                                                      STATE OF HAWAII — DEPARTMENT OF TAXATION  
                                     (Rev. 2022)                                                                                                                                                                                                             DO  NOT WRITE IN THIS AREA       20
                                                                                                                                                    TRANSIENT ACCOMMODATIONS 
                                                                                                                        ID NO 01                                  TAX RETURN 
                                                                                                                                                 For periods beginning AFTER December 31, 2017
                                     TA1_I 2022A 01 VID01

                                         Place an “X” in this box ONLY if this is an AMENDED return

                                                                                                  PERIOD ENDING                                                   (MM YY)          HAWAII TAX I.D. NO.    TA

                                                                                                  NAME:____________________________________                                                   Last 4 digits of your FEIN or SSN    
                                                                                                                                                         Column a                         Column b                                                                         Column c
                                                                                                                      DISTRICT                      GROSS RENTAL OR                       EXEMPTIONS/DEDUCTIONS                                                      TAXABLE PROCEEDS
                                                                                                                                                  GROSS RENTAL PROCEEDS                   (Explain on Reverse Side)                                                  (Column a minus Column b)

                                                                                                                    1.  OAHU                                                                                                                                                                     1
                                                                                                                                                                       .                                  .                                                                             .
                                                                                                                    2. MAUI, MOLOKAI, LANAI                                                                                                                                                      2
                                                                                                                                                                       . .                                . .                                                                           . .

                                                         PART I — TRANSIENT                                         3.  HAWAII                                         . .                                . .                                                                           . .      3
                                                                                                  ACCOMMODATIONS TAX
                                                                                                                    4.  KAUAI                                                                                                                                                                    4
                                                                                                                                                                       . .                                . .                                                                           . .
                                                                                                                                                                                                                                                                  TOTAL FAIR MARKET RENTAL VALUE
                                                                                                                    5. OAHU DISTRICT  ...................................................................................................................... 5. 
                                                                                                                                                                                                                                                                                        . .
                                                                                                                    6. MAUI, MOLOKAI, LANAI DISTRICT  ......................................................................................... 6. 
                                                                                                                                                                                                                                                                                        . .
                                                                                                                    7. HAWAII DISTRICT  .................................................................................................................... 7. 
                                                                                                  OCCUPANCY TAX                                                                                                                                                                         . .
                                     PART II — TIMESHARE 
                                                                                                                    8. KAUAI DISTRICT  ...................................................................................................................... 8. 
                                                                                                                                                                                                                                                                                        . .
                                                                                                    9.                 TOTAL AMOUNT TAXABLE. Add Column c of lines 1 through 4 and lines 5  
                                                                                                                       through 8. Enter result here (but not less than zero). ...............................................................................9. 
                                                                                                                                                                                                                                                                                        . .
                                                                                                   10.                 Tax Rate                                                                           10.                                                                      x0.1025
                                     PART III —COMPUTATION                                        11. TAX              TOTAL TAXES DUE. Multiply line 9 by line 10 and enter the result here. If you did  
• ATTACH CHECK OR MONEY ORDER HERE •                                                                                   not have any activity for the period, enter “0.00” here ...................................................... 11. 
                                                                                                                                                                                                                                                                                        . .
                                                                                                   12.  Amounts Assessed During the Period...                     PENALTY 
                                                                                                                                                                                                 . .
                                                                                                                       (For Amended Return ONLY)                                                          12. 
                                                                                                                                                                  INTEREST                       . .                                                                                    . .
                                                                                                   13.                 TOTAL AMOUNT.  Add lines 11 and 12. (For Amended Return ONLY) ........................... 13. 
                                                                                                                                                                                                                                                                                        . .
                                                                                                   14.  TOTAL PAYMENTS MADE FOR THE PERIOD (For Amended Return ONLY) ....................... 14. 
                                                                                                                                                                                                                                                                                        . .

                                                                            PART IV — ADJUSTMENTS  15.                 CREDIT TO BE REFUNDED.  Line 14 minus line 13 (For Amended Return ONLY) .............. 15.                                                                       . .
                                                                                                   16.                 ADDITIONAL TAXES DUE.  Line 13 minus line 14 (For Amended Return ONLY) ................. 16. 
                                                                                                                                                                                                                                                                                        . .

                                     DECLARATION - I declare, under the penalties set forth in section 231-36, HRS, that this return (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 return, made in good faith for the tax period stated, pursuant to the 
                                                                                                                       Transient Accommodations Tax Laws, and the rules issued thereunder.
                                                                                                                       IN THE CASE OF A CORPORATION OR PARTNERSHIP, THIS RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR MEMBER, OR DULY AUTHORIZED AGENT.
                                                                                                                       SIGNATURE                                             TITLE               DATE                                                                      DAYTIME PHONE NUMBER 

                                                                                                                               Continued on page 2 — Parts V & VI                                                                                                                  (Rev. 2022)  
                                     TA11E3T4                                                                                                                                                 MUST be completed                                                                    Form TA-1       
                                                                                                                                                                                                                                                                                                20

FORM TA-1 
(Rev. 2022)                                                  Name:___________________________________________________

                                                             Hawaii Tax I.D. No.  TA

TA1_I 2022A 02 VID01                                         Last 4 digits of your FEIN or SSN                                                                        PERIOD ENDING (MM YY)
                                                                                                                                                                                             
                                                  17. FOR LATE                                     PENALTY  
                                                                                                                                                . .
                                                                                                                                                                                        17. 
                                                      FILING ONLY                                  INTEREST                                      . .                                                     . .
                                                  18. TOTAL AMOUNT DUE AND PAYABLE(Original Returns, add lines 11 and 17;    
                                                      Amended Returns, add lines 16 and 17) ........................................................................................18. 
                                                                                                                                                                                                         . .
                                                  19. PLEASE ENTER THE AMOUNT OF YOUR PAYMENT.  Attach a check or money order  
                                                      payable to “HAWAII STATE TAX COLLECTOR” in U.S. dollars drawn on any U.S. bank to  
                                                      Form TA-1. Write “TA,” the filing period, and your Hawaii Tax I.D. No. on your check or money order.   
                                                      Mail to: HAWAII DEPARTMENT OF TAXATION, P. O. Box 1425, HONOLULU, HI  96806-1425  
                                                      orhitax.hawaii.gov If.you are NOT submitting a payment with                                                                                                                        file and pay electronically at 
                         PART V — TOTAL AMOUNT DUE
                                                      this return, please enter “0.00” here. ...........................................................................................19.              . .
                                                                        PART VI — SCHEDULE OF EXEMPTIONS/DEDUCTIONS
Note: Most ordinary business expenses are NOT DEDUCTIBLE (e.g., materials, supplies, etc.) on your transient accommodations tax return. For more information, see 
the Form TA-1 Instructions.
                                                  You must explain your exemptions and deductions, otherwise they will be disallowed and you will owe more taxes. 
  DISTRICT / ED CODE                                         AMOUNT                                DISTRICT / ED CODE AMOUNT                                           DISTRICT / ED CODE   AMOUNT

                                                                           .                                                                   .                                                               .
                                                                           .                                                                   .                                                               .
                                                                           .                                                                   .                                                               .
                                                                           .                                                                   .                                                               .
Grand Total of Exemptions and Deductions — Add the amounts above in Part VI and enter here. If more space is needed,  
attach a schedule. Include the total deductions claimed from any attachments in this total. (See Instructions)               ....................                                                              .
Additional Instructions for Exemptions/Deductions (ED)
For each exemptions/deductions you have claimed, enter: 
                                                  1.  For the “DISTRICT” column, enter the number that represents the Tax District from which the income was earned.  
                                                      1 = Oahu; 2 = Maui; 3 = Hawaii; and 4 = Kauai
                                                  2.  For the ED Code please see the list of codes below and enter the corresponding Exemption/Deduction code. 
                                                  3.  Enter your total amount of the exemption/deduction claimed for that District and ED Code.
                                                  Example:  Taxpayer A received gross rental proceeds of $2,000.00 from the Consul General of the Philippines for lodging on Maui. Taxpayer A 
                                                             enters the following to justify the deduction entered in Part I, Line 2, Column b of the Transient Accommodations Tax Return:
                                                                                      DISTRICT / ED CODE              AMOUNT
                                                                                                   2  1 10                2 0 0 0 .0 0
                                                                                             
Description (HRS)                                                       ED Code             Description (HRS)               ED Code                                   Description (HRS)                  ED Code
Complimentary Accommodations (§237D-3(7)) .....100                                          Nonprofit Organization, Lodging provided by a                             Temporary Lodging Allowance for military 
Diplomats and Consular Officials (§237D-3(8)) ......110                                            (§237D-3(3)) .................................................140   (§237D-3(4)) .................................................180
Federal or state subsidized lodging                                                         School Dormitories (§237D-3(2)) .......................150                Working Fringe Benefit (§237D-3(7)) ................190
  (§237D-3(5)) .................................................120                         Students —  
Health care facilities defined in HRS§321-11(10)                                                   Full-time Post-secondary (§237D-3(6)) ........160 
  (§237D-3(1)) .................................................130                                Summer Employment (§237D-3(6)) .............170

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TA12E3T4                                                                                           ID NO 01