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1350 STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
I-312
NONRESIDENT TAXPAYER REGISTRATION (Rev.4/18/24)
dor.sc.gov AFFIDAVIT INCOME TAX WITHHOLDING 3323
Mail to: The company or individual you are contracting with.
The undersigned nonresident taxpayer hereby certifies as follows:
Legal business name: FEIN:
Trade name if applicable (doing business as):
Mailing address:
City: State: ZIP:
Check and complete one:
Hiring or contracting with:
Name:
Mailing address:
City: State: ZIP:
Receiving rentals or royalties from:
Name:
Mailing address:
City: State: ZIP:
I hereby certify that the above named nonresident taxpayer is currently registered with (check the appropriate box):
The South Carolina Secretary of State (SCSOS) or
The South Carolina Department of Revenue (SCDOR):
Date of registration:
I understand that by this registration, the above named nonresident taxpayer has agreed to be subject to the jurisdiction
of the SCDOR and the courts of South Carolina to determine its South Carolina tax liability, including estimated taxes,
together with any related interest and penalties.
I understand the SCDOR may revoke the withholding exemption granted under SC Code Section 12-8-550 (temporarily
doing business or professional services in South Carolina) or SC Code Section 12-8-540 (rentals) at any time it
determines that the above named nonresident taxpayer is not cooperating with the SCDOR in the determination of its
correct South Carolina tax liability.
I hereby certify that I have examined this affidavit and to the best of my knowledge and belief, it is true, correct, and
complete. I understand that under SC Code Section 12-54-44 (B)(6)(a), I can be fined and/or imprisoned for furnishing
a false statement.
Signature of nonresident taxpayer (owner/partner/corporate officer when relevant) Date
Print name If corporate officer, state title
33231044
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