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13501350
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE SC8453C
CORPORATE INCOME TAX (Rev. 7/22/09)
DECLARATION FOR ELECTRONIC FILING 3415
Part 1: Corporation and Tax Return Information
Corporation Name FEIN
1. Federal taxable income Check form filed: SC1120, line 1; SC1120S, line 1 1 00
2. SC Corporate Income Tax (SC1120, line 7; SC1120S, line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 00 D
3. Total Payments and Refundable Credits (SC1120, line 15, SC1120S line 9). . . . . . . . . . . . . . . . . . . . . . . 3 00 O
Part 2: Declaration of Taxpayer/Corporate Officer
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Under penalties of perjury, I declare I am an officer of the above corporation and to the best of my knowledge and belief, O
the information on this South Carolina Corporate Income Tax Return is true, correct, and complete.
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If I have filed a balance due return, I understand that if the SC Department of Revenue does not receive full and timely
payment of the tax liability, I will remain liable for the tax liability and all applicable interest and penalties. M
A
I declare that I have compared the information on the corporate return with the information provided to the electronic
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return originator (ERO) and the amount agrees with the amounts on the South Carolina corporate tax return. To the best
of my knowledge, the return is true and complete. I consent that the return and accompanying schedules and statements L
be sent to the Internal Revenue Service (IRS) by the ERO, and subsequently by the IRS to the SC Department of
Revenue.
Signature Date
Sign
Here Title Paid Preparer Authorization:* K
Check here if the Department of Revenue may
discuss the return with the preparer shown below.
E
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Part 3: Declaration of Electronic Return Originator (ERO)/Paid Preparer
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Under penalties of perjury, I declare that I have reviewed the above corporation’s return and to the best of my knowledge
and belief, the information on this South Carolina Corporate Income Tax Return is true, correct, and complete.
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I declare that I have received the above taxpayer’s return and the entries on this form are complete and correct to the best O
of my knowledge. I have obtained the corporate officer’s signature on this form before submitting the return to the SC R
Department of Revenue. I have provided the taxpayer with a copy of all forms and information to be filed with the SC
Department of Revenue, and have followed all IRS requirements specified by the IRS and SC Department of Revenue. If Y
I am the preparer, I declare that I have examined the above taxpayer’s return and accompanying schedules and
statements, and to the best of my knowledge, they are true and complete. This declaration is based on all information of O
which I have knowledge. U
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ERO Date Check if Check if PTIN or FEIN
ERO's also paid self-
signature preparer employed
Use R
Only Firm name (or
yours if self-employed) E
Paid Preparer Date Check if PTIN or FEIN C
signature self-
Preparer's employed O
Use Firm name (or R
yours if self-employed)
Only and address ZIP code D
S
34151027
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