South Carolina Department of 
                                                       
 Revenue                                               
 Data to be Used for Creating Sample                   
 Forms for Income (SC1040-ES)(2024)                    
 Revised 05-15-2023                                    
 You must submit 1 form for each example, for a        
 total of five test cases. Submissions will not be     
 approved if the correct number of test cases is not   
 provided and/or if South Carolina test cases are not  
 used. 
                                                       
                                                       Coupon 4: 
 Coupon 1: 
                                                       Primary SSN:      555-55-5555 
 Primary SSN:       111-11-1111 
                                                       Secondary SSN:    777-77-7777 
 Secondary SSN:     None 
                                                       Primary Taxpayer: Sammy McOwes 
 Primary Taxpayer:  Income Jones 
                                                       Secondary Taxpayer: Sally McOwes 
 Secondary Taxpayer:  NA 
                                                       Address:          123 Bill Lane Apt 23A 
 Address:           123 Time to File
                                                                         Anywhere SC 29999 
                    Anywhere SC 29999 
                                                       Composite Filer:  No 
 Composite Filer:   Yes 
                                                       Period Covered:   12-24 
 Period Covered:    03-24 
                                                       Payment amount:   $100.00 
 Payment amount:    $100.00 
                                                       
 Coupon 2:                                             Coupon 5: 
 Primary SSN:       666-66-6666                        Primary SSN:      888-88-8888 
 Secondary SSN:     222-22-2222                        Secondary SSN:    None 
 Primary Taxpayer:  Paying Joe                         Primary Taxpayer: Owing O Connor 
 Secondary Taxpayer: Spending Joe                      Secondary Taxpayer:  NA 
 Address:           PO Box 1234                        Address:          Blurnfad 15
                    APO AP 29999                                         41516 Frankfurt Germany 
 Composite Filer:   No                                 Composite Filer:  Yes 
 Period Covered:    06-24                              Period Covered:   03-24 
 Payment amount:    $200.00                            Payment amount:   $148.00 
 
 Coupon 3: 
 Primary SSN:       333-33-3333 
 Secondary SSN:     444-44-4444 
 Primary Taxpayer:  Penny Pa 
 Secondary Taxpayer: Doll Pa 
 Address:           PO Box 1
                    Anywhere SC 29999-1204 
 Composite Filer:   No 
 Period Covered:    09-24 
 Payment amount:    $1.00