SOUTH CAROLINA DEPARTMENT OF REVENUE SID# 1350 TAX ...

1 Monthly15. Location of Records (No Box)11. How Would You Like to File? ,listmonthsactive:13. How Many Retail Sales Locations Do You Operate in under Your Ownership?Quarterly(SeeInstructions)You must file a zero return for periods with no sales. See Instructions for Filing (DoingBusinessAs)In and out-of-state sellers. A retail license will not be issued to a person with any outstanding state tax Main Business ( , Retail Sales, Manufacturing, Service, etc.)Section B: Retail Sales/Accommodations/Artist & Craftsman License/Use Tax17. Anticipated Date of First Retail Sales mm/dd/yySOUTH CAROLINA DEPARTMENT OF REVENUETAX REGISTRATION :SCDEPARTMENTOFREVENUEREGISTRATIONUNITCO LUMBIA,SC29214-0140 SCDOR-111(Rev.)

2 12/20/11)80481350 SID#_____W/H_____SALES_____USE _____PARTNERSHIP _____LICENSE TAX _____80481013 Complete Page 2 of This Form to Apply for Withholding TaxLead Acid Batteries19. Check If You Sell These ProductsMotor OilLarge AppliancesAgriculture, Forestry, Fishing, & Hunting (11)Mining (21)Utilities (22)Construction (23)Manufacturing (31-33)Wholesale Trade (42)Durable Medical Equipment (44)18. Type of BusinessMax Tax (Vehicles) (44)Retail Trade (44-45) Artists & Craftsman (45)Transportation & Warehouse (48-49)Information (51)Finance & Insurance (52)Real Estate, Rental & Leasing (53)Professional, Scientific, & Technical Services (54) Management of Companies & Enterprises(55)Administrative & Support, Waste Management & Remediation Services (56)Education Services (61)Health Care & Social Assistance (62) Arts, Entertainment, & Recreation (71)Accommodation & FoodServices (72)Other Services (81)Public Administration (92)

3 Please PrintUse Blue orBlack InkTiresService to Cellular and Personal Communications UsersAviation Gasoline/Jet FuelPrepaid Wireless CardsSection A: Taxes to be Registered for This Business Location - Make Checks Payable to SCDOR1. Owner, Partnership, or Corporate Charter Name2. FEIN SSN7. Email Address Sole Proprietor (one owner)Partnership (two or more owners, other than LLP)LLC/LLP filing as: Corporation Partnership Single MemberSouth CAROLINA Corporation Date IncorporatedForeign Corporation State and Date IncorporatedOther (explain)In Care Of3. Mailing Address (for all correspondence)CityStateZIPS treet5.

4 Business Phone Number 6. Daytime Phone Number8. Fax Number4. Type of city? Street9. Physical Location of Business (No Box) Required For All Tax TypesCityCounty(Required)StateZIPR etail Sales/Accommodations License ($50 license tax is required)Artist & Craftsman's License ($20 license tax is required)Use Tax (No fee required)Withholding Tax (Page 2)Nonresident Withholding Exemption (Page 2) state tax withholding. See instructions for more information. :02 :SCDEPARTMENTOFREVENUEIf you have questions about this form, please call (803) : :Allemployeesarehouseholdemployees,farme rs, UNITCOLUMBIA, SOUTH CAROLINA 29214-01408048201122.

5 Anticipated Date of First Payroll (mm/dd/yyyy):Thisdatewillbeusedastheopen dateofyourwithholdingaccount,andreturnsm ustbefiledbeginningwiththisdate regardless of , PartnersSection E: Name(s) of Business Owner, General Partners, Officers, or MembersHome AddressSocial Security NumberChecktheappropriateblocktoadminist rativelyregisterwiththeDepartmentandclai mexemptionfromnonresidentwithholdingrequ iredbySCCodeSections12-8-540(rentsandroy alties),12-8-550(temporarilydoingbusines sorperformingservicesinSC),or12-8-570(tr ustorestatebeneficiaries). ,includingwithholding,estimatedtaxes,and interestandpenalties, an admission of tax liability, and, does not, by itself, require the filing of a tax D: Nonresident Withholding ExemptionI agree to file SC tax return I am not subject to SC Tax Jurisdiction (no NEXUS)See instructions for further certify that all information on this application, including any attachments, is true and correct to the best of my ,ALLPARTNERS,ORCORPORATEOFFICERS ection C.

6 Withholding Tax Social Security Privacy Act (c)(2)(C)(i)permitsastatetouseanindividu al' ,asprescribed,forsecuringproper identification. Your social security number is used for identification purposes.