South Carolina Department of Revenue Data to be Used for Creating 
Sample Forms for SC1065ES (2023) 
Revised (06-29-2022) 
 
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. 
 
Voucher 1: 
FEIN:                03-9999999 
Tax period ending:   12-23 
Name:                TIME TRAVELERS 
Address:             1234 SECOND ST  
City/State/Zip:      ANYTOWN SC 20000 
Amount Due:            1000.00 
 
Voucher 2: 
FEIN:                68-9999999 
Tax period ending:   12-23 
Name:                TIME TRAVELERS 
Address:             1234 SECOND ST  
City/State/Zip:      ANYTOWN SC 20000 
Amount Due:          800.00 

Voucher 3: 
FEIN:                03-9999999 
Tax period ending:   12-23 
Name:                TIME TRAVELERS 
Address:             1234 SECOND ST  
City/State/Zip:      ANYTOWN SC 20000 
Payment amount:      1200.00 
 
Voucher 4: 
FEIN:                77-7777777 
Tax period ending:   12-23 
Name:                TIME TRAVELERS 
Address:             1234 SECOND ST 
City/State/Zip:      ANYTOWN SC 20000 
Payment amount:      2,800.00 
 
Voucher 5: 
FEIN:                57-9999999 
Tax period ending:   03-24 
Name:                TIME TRAVELERS 
Address:             1234 SECOND ST  
City/State/Zip:      ANYTOWN SC 20000 
Payment amount:      250.00