South Carolina Department of Revenue 
Data to be Used for Creating Sample Forms for WH-1601 (2023)
Revised 8/26/22 

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
Quarter:                   1st Qtr Jan, Feb, Mar 
Year:                      2023
Name and address:          Withholding Returns 
                           Inc. 123 Time to File 
                           Anywhere SC 29999 
Payment amount:            829.47

Return 2:
Withholding File Number  : 11111112- 7 
FEIN:                      57-0000002
Quarter:                   2nd Qtr Apr, May, Jun 
Year:                      2023
Name and address:          Bill It Now, Inc
                           John and Sally Withholds 
                           1234 Time to Pay 
                           Anywhere SC 29999 
Payment amount:            25.11

Return 3: 
Withholding File Number:  11111113-6 
FEIN:                      57-0000003
Quarter:                   3rd Qtr Jul, Aug, Sep 
Year:                      2023
Name and address:          Owes Inc. 
                           123 Bill Lane 
                           Anywhere SC 29999 
Payment amount:            5,500.00 

South Carolina Department of Revenue 
Data to be Used for Creating Sample Forms for WH-1601 (2023)
Revised 8/26/22 

Return 4: 
Withholding File Number:   11111114-5 
FEIN:                    57-0000004
Quarter:                 4th Qtr Oct, Nov, Dec 
Year:                    2023
Name and address:        March Filers Inc. 
                         3 Bill St 
                         Anywhere SC 29999 
Payment amount:          750.00 

Return 5: 
Withholding File Number: 11111115- 4
FEIN:                    57-0000005
                         st
Quarter:                 1  Qtr Jan, Feb, Mar
Year:                    2023
Name and address:        Gotta Withhold
                         123 Withhold Lane 
                         Anywhere SC 29999-9999 
Payment amount:          234,789.78