State of Hawaii - Department of Business, Economic Development & Tourism
Hawaii Film Office - 250 South Hotel Street, Honolulu, Hawaii 96813
Mailing Address: P.O. Box 2359, Honolulu, Hawaii, 96804-2359
Telephone: (808) 586-2570; Fax: (808) 586-2572
FROM: Hawaii Film Office TO:

FILM PERMIT APPLICATION: General Information Section
1. APPLICANT (Company Name):
2. PROJECT NAME:
3. ADDRESS:

4. PHONE #:FAX #:

5. ON-SITE CONTACT (Name & Phone #):6. HAWAII ADDRESS (If different from above):

PHONE #:

FAX #:

Pgr. / Cel. #:STATISTICAL INFORMATIONPROJECT TYPE:

FORMAT:
Budget:Feature FilmTV Commercial
Music VideoTV Episode / Special / MOW
Travelog / Industrial / Video stock / Tour video
Sports / Exercise
MiscellaneousStill$Print Ad. / Stock / Calendar / Mag.
Documentary / Educational / News
Hawaii-based Network TV seriesMulti Media CD ROM

16mm; 35mm; 70mm movie film
Hawaii Expenditure:$# Local Employees:

Video# HI Shoot Days:

7. FILM LOCATION REQUESTED, DATES AND TIMES (To make processing easier and faster,
please attach a map of the exact location requested, or street address, Tax Map Key number, or describe inas much detail as possible. If necessary, attach a separate sheet with additional location information.):a)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)

b)

c)

d)

e)
Continued on "FILM PERMIT APPLICATION: Specific Information Section"
FIPAC #Revised on 3/17/00

State of Hawaii - Department of Business, Economic Development & TourismHawaii Film Office - 250 South Hotel Street, Honolulu, Hawaii 96813
Mailing Address: P.O. Box 2359, Honolulu, Hawaii, 96804-2359
Telephone: (808) 586-2570; Fax: (808) 586-2572

FILM PERMIT APPLICATION: General Information Section
7. FILM LOCATION REQUESTED, DATES AND TIMES (Continued)
APPLICANT (Company Name):
PROJECT NAME:FILM LOCATION REQUESTED, DATES AND TIMES (To make processing easier and faster, please attach
a map of the exact location requested, or street address, Tax Map Key number, or describe in as much detailas possible. If necessary, attach a separate sheet with additional location information.):f)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)(Name of Location)(Island)(Dates and Time)g)h)i)j)k)l)m)n)o)Continued on "FILM PERMIT APPLICATION: Specific Information Section"
FIPAC #Revised on 3/17/00

FILM PERMIT APPLICATION: Specific Information Section(Complete this section for EACH location requested.)
Applicant:Project Name:(Name of Location)(Island)(Dates and Time)

8. DESCRIBE ACTIVITY YOU WILL BE FILMING / TAPING AT THE LOCATION:

9. TOTAL NUMBER OF PEOPLE (CAST AND CREW) ON LOCATION?
10. DESCRIBE ALL EQUIPMENT AND VEHICLES ON LOCATION (Indicate Parking Plans):
a. Equipment:

b. Vehicles:

11.

c. Parking Plans:DESCRIBE ANY USE OF BOATS / THRILL CRAFTS / PLANES / HELICOPTERS /RECREATIONAL VEHICLES / PYROTECHNICS / SPECIAL EFFECTS / ANIMALS AND / OR ANYOTHER PROPS (Attach a separate sheet if necessary):

Applicant / Authorized Signature

Date

Both production company and its Hawaii representative or agent are responsible for the locations
and activities listed herein.

FOR USE BY HAWAII FILM OFFICE AND / OR GOVERNMENT AGENCIESSUBMITTED BY:

SENT TO:
Hawaii Film Office Staff Signature

AgencyDateAgency

Date

APPROVED / DENIED BY:Signature
Approved Subject to:Special / Standard Conditions

General Conditions

Additional Conditions

Obtaining approval from County Gov’t. / Federal Gov’t. / Private Land Owner
INSURANCE:

Required

FAXED / SENT TO:

Not Required

Applicant

DOT (Air. / Har. / Hwys.)DAGS

DBEDT (HCDA)

Attached

On File with the Film Office

DLNR (DOBOR / DOCARE / DOFAW / LM / NARS /Parks)
Judiciary

UH (IfA)

Other:COMMENTS / ADD’L CONDITIONS / NOTES:

Fees$

Revised on 3/17/00.

Make payable to STATE OF HAWAIIFIPAC#.