Form N-172 must be signed by both the taxpayer-claimant (on the front of the form) and by the certifying physician, optometrist, audiologist (on the back of the form).
Where to send: Submit the original and one copy of Form N-172 to the Hawaii Department of Taxation, ATTN: Licensing Section.
Account: If the taxpayer has more than one general excise tax account that qualifies for the disability treatment, submit a separate Form N-172 for each such account.
Re-examination: If re-examination is indicated, a new Form N-172 should be submitted for the year indicated.
Certification: Complete only one section, even if applicant has multiple disabilities.
Rejection: This form may be rejected if the appropriate section and the certification are not fully completed.
| Question | Answer |
|---|---|
| Form Name | Form N-172 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 33 |
| Avg. time to fill out | 6 min |
| Edition | 2020 |
| Issuing agency | Hawaii Department of Taxation |
| Where to send | Hawaii Department of Taxation, ATTN: Licensing Section |
| Matches the agency's file | Yes, checked October 1, 2026 |
| Other names | N-172, N172, Form N-172, Hawaii N-172, Claim for Tax Exemption by Person with Impaired Sight or Hearing |
| Official source | Form N-172 (Rev 2020), Hawaii Department of Taxation |
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