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   1350                              STATE OF SOUTH CAROLINA
                                     DEPARTMENT OF REVENUE                                      I-41 
                                     NONRESIDENT BENEFICIARY AFFIDAVIT AND                      (Rev. 7/14/23) 
   dor.sc.gov                                                                                   3346
                                     AGREEMENT INCOME TAX WITHHOLDING

I certify and agree to the following:

1. I am a nonresident beneficiary.

2. Name:

   Address:
                                                         Street address

                                                         City, state, ZIP
3. SSN/FEIN:

4. The income this affidavit and agreement applies to is:

          Distribution of South Carolina taxable income from a trust

          Distribution of South Carolina taxable income from an estate

5. Fiduciary's name:

6. Fiduciary's address:
                                                         Street address

                                                         City, state, ZIP
7. Fiduciary's FEIN:

8. I agree to timely file appropriate returns and make payment of all South Carolina taxes required by law.

9. I agree that I am subject to the personal jurisdiction of the SCDOR and the courts of South Carolina for the purpose of 
   determining and collecting any South Carolina taxes, including estimated taxes, together with any related interest and 
   penalties.

10. This agreement will be binding upon my heirs, representatives, assigns, successors, executors, and administrators.

I declare under penalty of perjury that I have examined this affidavit and that, to the best of my knowledge and belief, it is 
true, correct, and complete. 
 
Under SC Code Section 12-54-44(B)(6)(a), a person who willfully makes and subscribes any return, statement, or other 
document that contains, or is verified by, a written declaration made under penalties of perjury that they do not believe to be 
true and correct as to every material matter is guilty of a felony and, upon conviction, must be fined not more than $500 or 
imprisoned not more than five years, or both, together with the cost of prosecution. 

Signature of beneficiary                                                             Date

Print name

   33461021

                                       INSTRUCTIONS

Requirement to Make Withholding Payments 
 
SC  Code  Section  12-8-570  requires  a  trust  or  an  estate  to  withhold  taxes  on  each  nonresident  beneficiary's  share  of 
South Carolina taxable income. The withholding is computed at South Carolina's top marginal Individual Income Tax rate 
for the tax year. 
 
Purpose of Affidavit 
 
A trust or estate is not required to withhold taxes from any nonresident beneficiary who submits this completed affidavit 
and agreement. Any Income Tax due must be paid by the original due date of the nonresident beneficiary's return and is 
subject to the declaration of Estimated Tax rules. 
 
Where and When to Submit This Affidavit 
 
Beneficiary Instructions:  
 
A nonresident beneficiary should fully complete the affidavit and submit it directly to the trust or estate. The affidavit is 
valid for subsequent years and should not be resubmitted. 
 
Trust or Estate Instructions:  
 
The trust or estate must submit all affidavits to the SCDOR. 
 
Attach all affidavits to the SC1041, Fiduciary Income Tax Return or the SC8736, Request for Extension of Time to File 
South Carolina Tax Return for Fiduciary and Partnership, due by the 15th day of the fourth month following the close of 
the trust or estate's tax year. 
 
Affidavits  remain  valid  for  subsequent  tax  years  and  must  only  be  filed  with  the  SCDOR  in  the  first  year  that  the 
nonresident beneficiary submits an affidavit to the trust or estate. 
 
More information on filing requirements for Individual Income Tax is available at dor.sc.gov/iit. More information on filing 
requirements for Fiduciary Income Tax is available at dor.sc.gov/tax/fiduciary.

Social Security Privacy Act Disclosure 
It is mandatory that you provide your Social Security Number on this tax form if you are an individual taxpayer. 42 U.S.C. 405(c)(2)(C)(i) 
permits a state to use an individual's Social Security Number as means of identification in administration of any tax. SC Regulation 
117-201  mandates  that  any  person  required  to  make  a  return  to  the  SCDOR  must  provide  identifying  numbers,  as  prescribed,  for 
securing proper identification. Your Social Security Number is used for identification purposes. 
The Family Privacy Protection Act 
Under the Family Privacy Protection Act, the collection of personal information from citizens by the SCDOR is limited to the information 
necessary for the SCDOR to fulfill its statutory duties. In most instances, once this information is collected by the SCDOR, it is protected 
by law from public disclosure. In those situations where public disclosure is not prohibited, the Family Privacy Protection Act prevents 
such information from being used by third parties for commercial solicitation purposes.