Form 110 - Retail License Application For Artists And Craftsmen - 2008
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1
2STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
FORM 110
RETAIL LICENSE APPLICATION FOR
(Rev. 2/27/08)
8009
ARTISTS AND CRAFTSMEN
TELEPHONE (803) 896-1350
For Office Use
License Tax of $20.00 Required
SID No.
PLEASE PRINT OR TYPE ALL INFORMATION
File No.
14-2601
1. OWNER, PARTNERS OR CORPORATE NAME
2. TRADE NAME (DOING BUSINESS AS)
3. PHYSICAL LOCATION OF BUSINESS REQUIRED (No P.O. Box)
4. PHONE NUMBER
5. FEDERAL IDENTIFICATION NUMBER
STREET
7. PLEASE DESCRIBE THE ITEM(S) YOU WILL BE SELLING
CITY
COUNTY
STATE
ZIP
THAT YOU HAVE CREATED OR ASSEMBLED.
6. MAILING ADDRESS (IF DIFFERENT)
IN CARE OF
STREET
CITY
COUNTY
STATE
ZIP
8. LOCATION OF RECORDS
9. TYPE OF OWNERSHIP
SOLE PROPRIETOR
LLC/LLP
(one owner)
UNINCORPORATED ASSOCIATION; ENTER LEGAL NAME.
PARTNERSHIP
SC CORPORATION DATE INC.
(two or more owners)
FOREIGN CORPORATION (attach copy of articles or certificate of authority).
OTHER (EXPLAIN)
10. NAMES OF BUSINESS OWNER, PARTNERS OR OFFICERS:
IF PARTNER
ADDRESS
SOCIAL SECURITY NUMBER
NAME/TITLE
PERCENT OWNED
1
2
3
4
12.
11. ANTICIPATED DATE
IS YOUR BUSINESS SEASONAL?
YES
NO
OF FIRST SALE
IF YES, LIST MONTHS ACTIVE
Social Security Privacy Act Disclosure
It is mandatory that you provide your social security number on this tax form, if you are an individual. 42 U.S.C 405(c)(2)(C)(i) permits a state to use
an individual's social security number as means of identification in administration of any tax. SC Regulation 117-1 mandates that any person required
to make a return to the SC Department of Revenue shall provide identifying numbers, as prescribed, for securing proper identification. Your social
security number is used for identification purposes.
I/WE HEREBY CERTIFY THAT I/WE WILL BE SELLING AT ARTS AND CRAFTS SHOWS OR FESTIVALS ART OBJECTS AND/OR CRAFTS
ITEMS THAT I/WE HAVE CREATED OR ASSEMBLED.
SIGNATURE OF OWNER, PARTNER OR CORPORATE OFFICER
TITLE
DATE
80091028
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