South Carolina Department of Revenue 
 Data to be Used for Creating Sample Forms for 
 WH1605 (2022) 
 Revised 8/18/22 
 
 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. 
 
 Return 1: 
 Withholding File Number:          11111111-8 
 FEIN:                             57-0000001 
                                   st
 Quarter:                          1  Quarter Jan, Feb, Mar 
 Year:                             2023 
 Amended:                          No 
 Change of Address:                No 
 Close Account:                    No 
  
 Name and Address:                 Withholding Returns Inc. 
                                   123 Time to File 
                                   Anywhere SC 29999 
 SC Tax Withheld Amount:           $46,418.97 
 Deposits or Payment Amount:       $42,896.59 
 Refund Amount:                    $ 
 SC Tax Due Amount:                $3,522.38 
 Penalty and Interest Due:         $53.00 
 Total Tax, Penalty, Int. Due:     $3,575.38 
 
 Return 2: 
 Withholding File Number:          11111112-7 
 FEIN:                             57-0000002 
                                   nd
 Quarter:                          2  Quarter Apr, May, Jun 
 Year:                             2023 
 Amended:                          No 
 Change of Address:                No 
 Close Account:                    Yes 
  
 Name and Address:                 Bill It Now, Inc 
                                   John and Sally Withholds 
                                   1234 Time to Pay 
                                   Anywhere SC 29999 
 SC Tax Withheld Amount:           $8,726.49 
 Deposits or Payment Amount:   $8,700.00 
 Refund Amount:                    $ 
 SC Tax Due Amount:                $26.49 
 Penalty and Interest Due:         $ 
 Total Tax, Penalty, Int. Due:     $26.49 

 South Carolina Department of Revenue 
 Data to be Used for Creating Sample Forms for 
 WH1605 (2022) 
 Revised 8/18/22 

 Return 3: 
 Withholding File Number:    11111113-6 
 FEIN:                       57-0000003 
                             rd
 Quarter:                    3  Quarter Jul, Aug, Sep 
 Year:                       2023 
 Amended:                    No 
 Change of Address:          No 
 Close Account:              No 
 
 Name and Address:           Owes Inc. 
                             123 Bill Lane 
                             Anywhere SC 29999 
 SC Tax Withheld Amount:     $4,751.00  
 Deposits or Payment Amount: $4,750.00 Refund 
 Amount:                     $ 
 SC Tax Due Amount:          $1.00 
 Penalty and Interest Due:   $ 
 Total Tax, Penalty, Int. Due:          $1.00 
 
 Return 4: 
 Withholding File Number:    11111114-5 
 FEIN:                       57-0000004 
                             st
 Quarter:                    1  Quarter Jan, Feb, Mar 
 Year:                       2023 
 Amended:                    Yes 
 Change of Address:          No 
 Close Account:              No 
 
 Name and Address:           March Filers Inc. 
                             3 Bill St 
                             Anywhere SC 29999 
 SC Tax Withheld Amount:     $28.11 
 Deposit or Payment Amount:  $20.36 
 Refund Amount:              $ 
 SC Tax Due Amount:          $7.75 
 Penalty and Interest Due:   $ 
 Total Tax, Penalty, Int. Due:          $7.75 

 South Carolina Department of Revenue 
 Data to be Used for Creating Sample Forms for 
 WH1605 (2022) 
 Revised 8/18/22 

 Return 5: 
 Withholding File Number:    11111115-4 
 FEI/EI#:                    57-0000005 
                             nd
 Quarter:                    2  Quarter Apr, May, Jun 
 Year:                       2023 
 Amended:                    No 
 Change of Address:          Yes 
 Close Account:              No 
 
 Name and Address:           Gotta Withhold 
                             123 Withhold Lane 
                             Anywhere SC 29999-9999 
 SC Tax Withheld Amount:     $6,821.37 
 Deposits or Payment Amount: $6,899.60 
 Refund Amount:              $78.23 
 SC Tax Due Amount:          $ 
 Penalty and Interest Due:   $ 
 Total Tax, Penalty, Int. Due:          $