Form GEW-TA-RV-1 Notification of Cancellation of General Excise / Use, Withholding, Transient Accommodations, Rental Motor Vehicle and Tour Vehicle Accounts (Rev. 2009)

*The effective date should correspond to the last day of the last filing period required to be filed (even if the tax due is zero ) (Example: If the last filing period required to be filed is the 4th Quarter of 2010 the effective date of cancellation should be 12/31/2010 and not 1/1/2011 ) CANCEL MY TAX LICENSE(S) AS INDICATED BELOW: CANCEL MY TAX PERMIT(S) AS INDICATED BELOW: DEPARTMENT OF TAXATION DO NOT WRITE IN THIS AREA Doing Business As (DBA) Name FORM GEW TA RV 1 STATE OF HAWAII (REV 2009) Hawaii Department of Taxation Instructions to Cancel Tax License(s): (1) Enter the type(s) of license(s) you are cancelling (e g general excise (GE) transient accom modations (TA) rental motor vehicle & tour vehicle (RVST) use tax only (Use) employer s withholding (WH) or seller s collection (SC)) in the License Type column (2) Enter the Hawaii Tax I D number(s) for the license(s) that you are cancelling in the Hawaii Tax I D No Column (3) Enter the effective date (Month Day Year) of cancellation for the tax license(s) that you are cancelling in the Effective Date column * Instructions to Cancel Tax Permit(s): (1) Enter the type(s) of permit(s) you are cancelling (e g liquor liquid fuel distributor liquid fuel retail dealer cigarette & tobacco (non retail) or retail tobacco) in the Permit Type column (2) Enter the permit number(s) for the permit(s) that you are cancelling in the Permit Number column (3) Enter the effective date (Month Day Year) of cancellation for the permit(s) that you are cancelling in the Effective Date column * License Type Hawaii Tax I D No Effective Date (MM/DD/YYYY) Licensing Section Mailing Address: NOTIFICATION OF CANCELLATION OF TAX LICENSES AND TAX PERMITS P O Box 1425 Honolulu HI 96806 1425 Permit Type Permit Number Hawaii Tax I D No Effective Date (MM/DD/YYYY) Print Name of Signatory Signature Filing & Payment Requirements: This form must be signed and sent to the Department of Taxation with the tax license(s)/ permit(s) that you are cancelling An unsigned cancellation notice will not be accepted All required periodic (monthly quarterly or semiannual) and annual tax returns must be filed up to the date of cancellation and all taxes due paid in full If the required returns and Signature of Owner Partner or Member Officer or Duly Authorized Agent taxes due are not filed and paid in full the tax license(s)/permit(s) will be cancelled as requested but your tax account(s) will remain open for actions by the Department of Taxation to the extent permitted by law Telephone Number THIS SPACE FOR DATE RECEIVED STAMP FORM GEW TA RV 1 01 Title Date