YOU ARE REQUIRED BY STATE LAW TO FILL OUT THIS AGRICULTURAL DECLARATION FORM. Anyperson who defaces this declaration form, gives false information, or fails to declare, prohibited or restrictedarticles in their possession, including baggage, or fails to declare these items on cargo manifests is in violationof Chapter 150A, Hawaii Revised Statutes, and may be guilty of a misdemeanor punishable, in certaininstances, by a maximum penalty of $25,000 and/or up to one year imprisonment. Intentionally smuggling asnake or other prohibited or restricted article into Hawai‘i is, in certain circumstances, a Class C felonypunishable by a maximum penalty of $200,000 and/or up to five years imprisonment.

One adult member of a family may complete this declaration for other family members.

Please submit all of the above-marked items in your possession and/or baggage for inspection to a Hawai‘iPlant Quarantine Inspector in the baggage claims area. The cargo agent will submit cargo for inspection onyour behalf.

If you are traveling with any LIVE ANIMALS, you must NOTIFY A CABIN ATTENDANT PRIOR TODEPLANING. All live animals must be turned in to the Honolulu Airport Animal Quarantine Holding Facility bythe transportation carrier, not the passenger, upon arrival.

NONE OF THE ABOVE

See Reverse Side

DogsCatsBirds

Reptiles (Turtles, Lizards, Snakes, etc.)Other Animals

B) I HAVE THE FOLLOWING ITEMS IN MY POSSESSION AND/OR BAGGAGE:

PLEASE LIST THE SPECIFIC TYPES/NAMES OF THE ITEMS MARKED ABOVE.(Items meeting State requirements will be inspected and released.)

4

31

2

Full Name (Print)

Hawai‘i Address or Name of Hotel/Lodging

Home Address

A) I HAVE THE FOLLOWING ITEMS IN MY POSSESSION AND/OR BAGGAGE:

Fresh Fruit & VegetablesCut Flowers & FoliageRooted Plants & Plant Cuttings, or AlgaeRaw or Propagative Seeds or Bulbs

Soil, Growing Media, Sand, etc.Live Seafood (lobsters, clams, oysters, etc.)Cultures of Bacteria, Fungi, Viruses, or ProtozoaInsects, Live Fishes, Amphibians, etc.

MANDATORY DECLARATION

ALOHA and Welcome to Hawai‘i. Many plants and animals from elsewhere in the world can be harmful toour unique environment, agriculture, and communities. Please help to protect Hawai‘i by not bringing harmfulpests into our state.

STATE OF HAWAI‘IDepartment of Agriculture

FOR ALL PASSENGERS, OFFICERS, AND CREW MEMBERS

PLANTS AND ANIMALS DECLARATION FORM

Origin (State or Country) of above items

Signature Date

Island Phone No.- -

No. in Party

City State Zip

Name of Airline/Ship Flight No. Date of Arrival/ /

SPANISHTAGALOG

JAPANESE

KOREAN

CHINESE

HTA Form Rev. 02-01-2016 Printed in U.S.A.

We welcome you to our home and hope you enjoy your stay with us.Mahalo (thank you) and Aloha!

ArgentinaAustraliaBrazilChinaFranceGermanyHong KongItalyJapanKoreaMexicoNew ZealandPhilippinesSingaporeSwitzerlandTaiwanUnited Kingdom

U.S.A. (provide Zip Code below)

Canada (provide postal code below)

Other (please specify)

1

2

3

4

5

6

7

8

9

0

1

2

3

4

5

6

7

8

9

0

1

2

3

4

5

6

7

8

9

0

1

2

3

4

5

6

7

8

9

0

1

2

3

4

5

6

7

8

9

0

1234567890

Aloha! On behalf of the State of Hawai‘i, thank you for visiting. Please take a few moments to complete the questions below. Thisinformation helps us ensure that the quality of your Hawai‘i experience remains the best it can be. Your answers are strictly confidentialand are tabulated for statistical purposes only. We greatly appreciate your assistance. Mahalo!

TO BE COMPLETED BY: Returning Hawai‘i residents, those moving to Hawai‘i, frequent or repeat visitors to Hawai‘i and our first time visitors alike.(PLEASE ANSWER BY COMPLETELY FILLING THE APPROPRIATE OVAL AND BOXES IN BLUE OR BLACK PEN.)

13. Of the people covered by this form (NOT including yourself), howmany are:

HoneymoonTo Get MarriedPleasure/VacationConvention/ConferenceCorporate MeetingIncentive Trip

Other BusinessVisiting Friends or RelativesGovernment or Military BusinessTo Attend SchoolSports EventOther (please specify):

10. The reason for this trip is:(RESIDENTS - MARK PURPOSE OF YOUR TRIP)(mark all that apply)

11. What is your age: 12. What is your gender:

Male Female

# Males # Females

12 yrs. or under

13 to 17 yrs.

18 to 24 yrs.

25 to 40 yrs.

41 to 59 yrs.

60 or more

TOTAL

9. Where will you stay while in Hawai‘i? (mark all that apply)

HotelCondominiumRental HouseTimeshare UnitBed & BreakfastCruise Ship

Friends or RelativesHostelCamp Site, Beach

Other (please specify):

14. I am a resident of:

7. On this trip, I am a member ofan organized tour group:

Yes No

8. I am on a pre-paid packagetrip that includes at leastairfare and lodging:

Yes No

STATE OF HAWAI‘IHAWAI'I TOURISM AUTHORITY

(Fill out one form per party/family)

5. Please mark the places you plan tovisit and the number of nights youplan to stay at that place (Write 0 ifday-only trip).

Visitor to Hawai‘i.Intended resident moving to Hawai‘i

Returning Hawai‘i resident.

for at least one year.(ANSWER QUESTIONS 11 TO 14 ONLY.)

2. I am a:

Number of nights away from Hawai‘i.

NIGHTS(ANSWER QUESTIONS 10 TO 14 ONLY.)

1. The total number of people(including myself) covered by this form is:

1 2 3 4 5 6 7 8 9 10

Plan to visit

4. Altogether, I/we will be in theHawaiian Islands for:

A few hours only.One night or more.

NIGHTS(CONTINUE TO QUESTION 5.)

3. This trip to Hawai‘i is my:

1st2nd3rd4th

5th6 to 10thMore than 10th

# of nights

Maui

Moloka‘i

Lana‘i

Kaua‘i

O‘ahu(Includes Waikikiand Honolulu)

(Big Island ofHawai‘i)

Hilo

(Big Island ofHawai‘i)

Kona

(STOP HERE)

-

>10

Yes No

6. [Answer if you plan to visit O‘ahu,otherwise skip to Q.7 ]

Are you or any member of your partyplanning on attending any events at theHawai‘i Convention Center?

# Males # Females

# Males # Females

15. E-mail Address (to participate in a follow-up survey):

All other countries (provide postal code below)

Private Room in Private HomeShared Room/Space in Private Home

HTA Form Rev. 02-01-2016 Printed in U.S.A.