13501350                                                  STATE OF SOUTH CAROLINA
                                                               DEPARTMENT OF  REVENUE
                                                                                                                               ST-299
                                 AFFIDAVIT FOR DELIVERY OF TANGIBLE PERSONAL                                                     (Rev. 7/15/10)
                                 PROPERTY TO THE PURCHASER IN A STATE OTHER                                                                                                    5039      ST-299
                                                                    THAN SOUTH CAROLINA                                                                                                    (Rev. 9/8/08)
                                                                        AFFIDAVIT                                                                                                           5039

STATE OF

COUNTY OF
Personally appeared the below named purchaser, who being duly sworn, deposes and says that the property listed below
is purchased for use, storage or other consumption outside of South Carolina, that the property will not be returned for
use, storage or other consumption in South Carolina, and that the purchaser has read and understands the law as printed
on the reverse side of this form.

Name of Purchaser

City and State of Delivery

State of Residence and
Address of Purchaser
                                                               (Street)           (City)                    (State)                                                         (Zip)

Name of Seller

Address of Seller
                                                               (Street)           (City)                    (State)                                                                 (Zip)

Seller's Retail License Number

Date of Sale
                                                               (Month)                                         (Date)                                                 (year)

DESCRIPTION OF PROPERTY:

Item:

Model:

Serial Number:

Purchase Price  $                                    Trade-In Allowance  $                                     Net Amt. Paid  $

Further deponent sayeth not.

                                                                                         (Signature of Purchaser)
Sworn to and subscribed before me

this              day of              , year of                    .

     (Notary Public for                                       )
                 VALID ONLY WITH PROOF OF DELIVERY OUTSIDE STATE OF SOUTH CAROLINA
                                                                    SEE REVERSE SIDE
                          ORIGINAL Provided for purchaser.                        Copy   Retained by seller.

     50391010

                             PROOF OF DELIVERY OUTSIDE SOUTH CAROLINA

Place of Delivery
                                                       (Street)              (City)                                                    (State)                                                                                          (Zip)

Date of Delivery                                                                       Time of Delivery

Means of Delivery (   ) U. S. Mail
                  (   ) Common Carrier (Name of Carrier)
                                                           Bill of Lading #
                  (   ) Seller or Agent of Seller (Affidavit below must be completed)

                                                                    AFFIDAVIT

STATE OF

COUNTY OF

Personally appeared before me
                                                                           Name of Seller/Agent of Seller
who being duly sworn deposes and says that the tangible personal  property described on the reverse side was delivered

by him to
                                                                    (Name of Purchaser)

at                                                                                                                                on   
                                                      .(Address)                                         (City)                          (State)                     (Zip)                                                        (Date)

Further depondent sayeth not.

                                                                                                       Signature of Person Making Delivery

Sworn to and subscribed before me

this              day of              , year of                    .

Notary Public for State of

(Section 12-36-2520.)       If the seller delivers tangible personal property to the purchaser in a state other than South
Carolina and receives from the purchaser a statement, given under oath, that the property was purchased for storage,
use, or consumption outside of South Carolina and that the property will not be returned for storage, use or consumption
in South Carolina, the sales or use tax due on the transactions will be transferred to the purchaser if the statement
contains a description of the property, the date of sale, the amount of the purchase price, and the city and state of
delivery. The statement must be retained by the seller and upon request forwarded to the department. The department
may forward a copy of the statement to the taxing authority of the state of delivery. If the property is subsequently stored,
used, or consumed in this State, the purchaser, in addition to the sales or use tax, shall pay a penalty in an amount equal
to fifty percent of the tax.

50392018