Form HRD319 "Hawaii State Residency Questionnaire" - Hawaii

What Is Form HRD319?

This is a legal form that was released by the Hawaii Department of Human Resources Development - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2005;
  • The latest edition provided by the Hawaii Department of Human Resources Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HRD319 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Human Resources Development.

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Download Form HRD319 "Hawaii State Residency Questionnaire" - Hawaii

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HRD 319 (Rev. 8/05)
STATE OF HAWAII
DEPARTMENT OF HUMAN RESOURCES DEVELOPMENT
State Recruiting Office
th
235 South Beretania St., 11
Floor
Honolulu, Hawaii, 96813-2437
HAWAII STATE RESIDENCY QUESTIONNAIRE
Print Name:_____________________________________________ SSN:_______________________
Job Applying For:_________________________________________ Date:_______________________
Under Hawaii law, applicants for public employment must be residents of the State of Hawaii at
the time of application. Hawaii Revised Statutes (HRS) § 78-1(c).
This law defines resident as “A person who is physically present in the State at the time the
person claims to have established the person’s domicile in the State and shows the person’s intent is to
make Hawaii the person’s permanent residence.”
“Domicile” means the place where a person has established his or her home with every intention
of making that place his or her permanent residence for an unlimited to indefinite period of time. A person
can have only one domicile at a time.
Please return the Questionnaire to the State Recruiting Office, Department of Human Resources
Development, at the address above.
With the definitions above as your point of reference, please complete the questions
below (answer “N/A” if a question is not applicable to you):
1.
I am a resident of the State of ________________________.
A.
I have been a resident of that state since [date]:_______________________.
Month, Year
B.
Before that, I was a resident of the state of __________________________.
(If you have resided only in one state, check here: ¨).
2.
Residency Indicators
A.
My home is in the State of _________________________.
B.
I live in this home ________ months out of each year.
C.
My home address is (P.O. Boxes or mailing addresses insufficient):________________
______________________________________________________________________
D.
I own home(s) in the state(s) of ____________________________. I live in this home
_____ months out of each year. The rest of the time, this home is ___rented ___ vacant
___ lived in by __________________________________________________________.
E.
I am registered to vote in the State of _____________________.
I plan to vote in the State of Hawaii in the next election.
Yes ____
No _____
continued on reverse
HRD 319 (Rev. 8/05)
STATE OF HAWAII
DEPARTMENT OF HUMAN RESOURCES DEVELOPMENT
State Recruiting Office
th
235 South Beretania St., 11
Floor
Honolulu, Hawaii, 96813-2437
HAWAII STATE RESIDENCY QUESTIONNAIRE
Print Name:_____________________________________________ SSN:_______________________
Job Applying For:_________________________________________ Date:_______________________
Under Hawaii law, applicants for public employment must be residents of the State of Hawaii at
the time of application. Hawaii Revised Statutes (HRS) § 78-1(c).
This law defines resident as “A person who is physically present in the State at the time the
person claims to have established the person’s domicile in the State and shows the person’s intent is to
make Hawaii the person’s permanent residence.”
“Domicile” means the place where a person has established his or her home with every intention
of making that place his or her permanent residence for an unlimited to indefinite period of time. A person
can have only one domicile at a time.
Please return the Questionnaire to the State Recruiting Office, Department of Human Resources
Development, at the address above.
With the definitions above as your point of reference, please complete the questions
below (answer “N/A” if a question is not applicable to you):
1.
I am a resident of the State of ________________________.
A.
I have been a resident of that state since [date]:_______________________.
Month, Year
B.
Before that, I was a resident of the state of __________________________.
(If you have resided only in one state, check here: ¨).
2.
Residency Indicators
A.
My home is in the State of _________________________.
B.
I live in this home ________ months out of each year.
C.
My home address is (P.O. Boxes or mailing addresses insufficient):________________
______________________________________________________________________
D.
I own home(s) in the state(s) of ____________________________. I live in this home
_____ months out of each year. The rest of the time, this home is ___rented ___ vacant
___ lived in by __________________________________________________________.
E.
I am registered to vote in the State of _____________________.
I plan to vote in the State of Hawaii in the next election.
Yes ____
No _____
continued on reverse
F.
My motor vehicle is registered in the State of __________________. (Attach a copy of
your current motor vehicle registration).
G.
I, or the person who claimed me as a spouse or dependent, filed my most recent resident
income tax return in the State of __________________ in [year]___________________.
I plan to file my next resident income tax return in the State of Hawaii. yes _____ no____
3.
If you have relocated to Hawaii within the last year, please answer the following questions:
A.
Where did you relocate from? _______________________________________________
B.
Reason for relocating: _____________________________________________________
C.
How long were you there?__________________________________________________
D.
If you owned your home at your former location, did you sell it? ____ Yes ____ No
E.
Did you leave any members of your immediate family behind? ____No ____ Yes
If yes, who? ____ spouse ____ minor child(ren) ____ adult child(ren) ____ parent(s)
4.
Military Personnel, Spouses, and Family. Military personnel or their families who are
stationed in Hawaii may be residents of the State, depending on individual circumstances.
Are you the spouse or dependent of, or otherwise sponsored by, an active duty military personnel
stationed in Hawaii? Yes ____
No _____ If no, skip to question 5. If yes:
A. Name of active duty personnel and relationship to you: _______________________________
_____________________________________________________________________________
B. Date of Assignment in Hawaii: __________________________________________________
C. State of Residence:
____________________________________________________________
____________________________________________________________________________
D. When State of Residence last
declared:_____________________________________________
E. We presently plan to live in the state of ________________________ when my/my spouse’s
or my dependent’s enlistment is over.
F. Please attach documents showing your military transfer to Hawaii, for example, orders,
housing assignments, or certified State of Legal Residency Certificate (Military DD 2058).
5.
During the hours of 7:45 am to 4:30 pm (Hawaii time), Mondays through Fridays, I can be
reached at the following telephone number(s):
1. ___________________________________ home/work/cell
2. ___________________________________ home/work/cell
I hereby certify that the statements made in this document are current and true and correct to the
best of my knowledge.
Signature:____________________________________________________ Date:___________________
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