S Corporation Income Tax Return Form

STATE OF HAWAII — DEPARTMENT OF TAXATION
N-35 S CORPORATION INCOME TAX RETURN

This space for date received stamp

For calendar year or other tax year beginning and ending

Name:

Dba or C/O:

Address (number and street):

City or town, State, and Postal/ZIP Code:

Federal Employer I.D. No.:

Business Activity Code:

Hawaii Tax I.D. No.:

Enter the number of Schedules NS attached to this return:

Is the corporation electing to be an S corporation beginning with this tax year? Yes No

Check if: Initial Return Final Return S Election Termination or Revocation Name Change Address Change

How many months in 2013 was this corporation in operation?   Was this corporation in operation at the end of 2013? Yes No

INCOME

1a Gross receipts or sales:

1b Returns and allowances:

1c Line 1a minus line 1b:

2 Cost of goods sold:

3 Gross profit:

4 Net gain or (loss) from Schedule D-1:

5 Other income:

6 TOTAL income (loss):

DEDUCTIONS

7 Compensation of officers:

8 Salaries and wages:

9 Repairs and maintenance:

10 Bad debts:

11 Rents:

12 Taxes and licenses:

13 Interest:

14 Depreciation:

15 Depletion:

16 Advertising:

17 Pension, profit-sharing, etc. plans:

18 Employee benefit programs:

19 Other deductions:

20 TOTAL deductions:

21 Ordinary income (loss):

DECLARATION

Signature of officer: Date:

Type or print name and title of officer:

May the Hawaii Department of Taxation discuss this return with the preparer shown below? Yes No

Page 2 — TAX & PAYMENTS / Schedule A / Schedule B

Name as shown on return: Federal Employer Identification Number:

22a Excess net passive income tax:

22b Tax from Schedule D:

22c Number of N-4’s attached: Taxes withheld on attached N-4’s:

22d LIFO recapture tax:

22e Add lines 22a, 22b, 22c, and 22d:

23a 2012 overpayment allowed as a credit:

23b 2013 estimated tax payments from N-3s: and N-288s:

23c Payments with extension:

23d Amount due on attached Form N-4’s:

23e Add lines 23a, 23b, 23c, and 23d:

24 Underpayment of estimated tax penalty: Form N-220 attached

25 OVERPAYMENT:

26a Credited to 2014 estimated tax:

26b Refunded:

27 TAX DUE:

28 PAYMENT DUE:

29 Amount paid (overpaid) on original return:

30 BALANCE DUE (REFUND):

Schedule A — Cost of Goods Sold

1 Inventory at beginning of year:

2 Purchases:

3 Cost of labor:

4 Additional IRC section 263A costs:

5 Other costs:

6 Total:

7 Inventory at end of year:

8 Cost of goods sold:

Schedule B — Other Information

Check method of accounting: Cash Accrual Other

Date of incorporation: Date business began in Hawaii:

Under laws of: Date of federal election as an S corporation:

Business Activity: Product or service:

Did the corporation own 50% or more of the voting stock of a domestic corporation? Yes No

Number of shareholders at end of tax year: Residents of Hawaii Nonresidents of Hawaii

Did the corporation derive income from sources outside Hawaii? Yes No

Net unrealized built-in gain:

Page 3 — Schedule K

Name as shown on return: Federal Employer Identification Number:

1 Ordinary income (loss) from trade or business activities:

2 Net income (loss) from rental real estate activities:

3a Gross income from other rental activities:

3b Expenses from other rental activities:

3c Net income (loss) from other rental activities:

4 Interest income:

5 Ordinary dividends:

6 Royalty income:

7 Net short-term capital gain (loss):

8 Net long-term capital gain (loss):

9 Net gain (loss) under IRC section 1231:

10 Other income (loss):

11 Charitable contributions:

12 IRC section 179 expense deduction:

13 Deductions related to portfolio income (loss):

14 Other deductions:

List of Shareholders

1 Name and Address:

SSN or FEIN: No. of shares owned:

State of Residence: Year Sch. NS filed: Amount of Payment on Form N-4 attached:

2 Name and Address:

SSN or FEIN: No. of shares owned:

State of Residence: Year Sch. NS filed: Amount of Payment on Form N-4 attached:

3 Name and Address:

SSN or FEIN: No. of shares owned:

State of Residence: Year Sch. NS filed: Amount of Payment on Form N-4 attached:

Apportionment of Income

1 Ordinary income (loss):

2 Apportionment factor:

3 Business income apportioned to Hawaii:

4 Business income apportioned elsewhere:

5 Are the totals the same as those reported to other states? Yes No

If “No,” please explain:

Computation of Apportionment Factors

Property values in Hawaii: Everywhere:

Property factor:

Total compensation in Hawaii: Everywhere:

Payroll factor:

Total sales in Hawaii: Everywhere:

Sales factor:

Average of factors:

Designation of Tax Matters Person

Name of designated TMP: Identifying number of TMP:

Address of designated TMP: