Clear Form

FORM ITPS-COA
 (REV. 2018)                  STATE OF HAWAII                                       DO NOT WRITE IN THIS AREA                                     
                         DEPARTMENT OF TAXATION                                                                                   03
             CHANGE OF ADDRESS FORM
      (NOTE: References to “married” and “spouse” are also references to  
          “in a civil union” and “civil union partner,” respectively.)

 Name                                                                                                       SSN or FEIN

 Spouse’s Name                                                                                              Spouse’s SSN

 Contact Phone Number (daytime)
 (       )

 PLEASE CHANGE MY:

   M AILING ADDRESS TO:                                                     BUSINESS ADDRESS (PHYSICAL LOCATION) TO: 
 c/o or “In care of”  (If this is to be deleted, please write “Delete”)   Street (This address cannot be a P.O. Box.)

 Street                                                                   City, State, Postal/Zip Code

 City, State, Postal/Zip Code                                             Business Phone Number             Residence Phone Number
                                                                          (       )                         (       )

 THE ADDRESS CHANGE IS FOR THE ACCOUNT(S), PERMIT OR LICENSE SHOWN BELOW:

   MY NET INCOME ACCOUNT

                                                                          For Hawaii Tax I.D. No. GE __ __ __-__ __ __-__ __ __ __-__ __
   MY GENERAL EXCISE ACCOUNT(S)                                          For Hawaii Tax I.D. No. GE __ __ __-__ __ __-__ __ __ __-__ __
                                                                          For Hawaii Tax I.D. No. GE __ __ __-__ __ __-__ __ __ __-__ __
                                                                          For Hawaii Tax I.D. No. WH __ __ __-__ __ __-__ __ __ __-__ __
   MY EMPLOYER’S WITHHOLDING ACCOUNT(S)                                  For Hawaii Tax I.D. No. WH __ __ __-__ __ __-__ __ __ __-__ __
                                                                          For Hawaii Tax I.D. No. WH __ __ __-__ __ __-__ __ __ __-__ __
                                                                          For Hawaii Tax I.D. No. TA __ __ __-__ __ __-__ __ __ __-__ __
   MY TRANSIENT ACCOMMODATIONS
                                                                          For Hawaii Tax I.D. No. TA __ __ __-__ __ __-__ __ __ __-__ __
       ACCOUNT(S)
                                                                          For Hawaii Tax I.D. No. TA __ __ __-__ __ __-__ __ __ __-__ __
                                                                          For Hawaii Tax I.D. No. RV __ __ __-__ __ __-__ __ __ __-__ __
   MY RENTAL MOTOR VEHICLE, TOUR VEHICLE
                                                                          For Hawaii Tax I.D. No. RV __ __ __-__ __ __-__ __ __ __-__ __
       AND CAR-SHARING VEHICLE ACCOUNT(S)
                                                                          For Hawaii Tax I.D. No. RV __ __ __-__ __ __-__ __ __ __-__ __
   MY______________________ PERMIT/LICENSE
          (Enter the type of permit or license. For                       Permit/License Number ____________
          example, liquor, liquid fuel distributor, liquid fuel 
          retail dealer, cigarette & tobacco (non-retail), or             For Hawaii Tax I.D. No.  ________________________________
          retail tobacco.)
 
                               Signature                                                              Title             Date

                               Spouse’s Signature                                                                       Date

                                                                                    — MAILING ADDRESS — 
                                                                                    HAWAII DEPARTMENT OF TAXATION
                                                                                    P.O. BOX 259
                                                                                    HONOLULU, HI 96809-0259             FORM ITPS-COA 03
ITPSCOA_I 2018A 01 VID01                                        ID NO 01