STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
C-245
APPLICATION FOR APPEAL
(Rev. 7/26/07)
6177
(Protest Pursuant to Revenue Procedures Act)
Section I:
Taxpayer Identification
Taxpayer Name (s):
(Please type or print)
Address:
City:
State:
Zip Code:
Telephone:
Period (s) Covered:
DRAFT
Type (s) of Tax (es):
8/1/07
__ Individual Income Tax
__ Sales and Use Tax
__ Corporate Income Tax
__ Employer Withholding Tax
__ Partnership Income Tax
__ Deed Recording Fee
__ Motor Fuel Tax
__ Liquor by the Drink Tax
__ Other (Specify)__________________________
Identification Number (Social Security Number, License Number, etc.):
Section II:
Department of Revenue Document to be Attached
Please attach a copy of the Department of Revenue document or notice you received which led to the filing of this protest.
Section III:
Reason for Protest
State all the reasons you disagree, including a statement of facts supporting your position and the law or other authority
upon which you rely. (If the amount of proposed assessment is less than $2,500 you need not provide your legal authority
unless you are a partnership, "S" corporation, an exempt organization or an employee plan and the proposed tax is
imposed by Chapters 6, 11, or 13 of Title 12.) Add additional sheets if necessary.
(over)
61771026