Form C-245 - Protest Pursuant To Revenue Procedures Act Page 2

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Taxpayer's Signature
Date
Spouse's Signature
Date
Business Entity Name (if applicable)
By
Title
Signature of Owner/Partner/Officer/LLC Member
Date
Print Name
INSTRUCTIONS
The purpose of this form is to reduce to writing those facts and issues with which you disagree. If more space is needed,
additional sheets may accompany this form. A protest may be filed by letter rather than using this form; however, all of the
information required by this form must be included in the letter and you must comply with the requirements concerning
signatures. If you file a joint income tax return, both you and your spouse must sign. If the protest is for a corporation, it
must include the corporation's name followed by the signature and title of the corporate officer authorized to sign. If you
have any questions concerning this matter, please call the telephone number on the notice or document with which you
disagree. Please return document to the Department of Revenue address shown on the notice or document with which
you disagree.
Social Security Privacy Act Disclosure
It is mandatory that you provide your social security number on this tax form. 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 117-201 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.
The Family Privacy Protection Act
Under the Family Privacy Protection Act, the collection of personal information from citizens by the Department of Revenue is limited to the information
necessary for the Department to fulfill its statutory duties. In most instances, once this information is collected by the Department, it is protected by law
from public disclosure. In those situations where public disclosure is not prohibited, the Family Privacy Protection Act prevents such information from
being used by third parties for commercial solicitation purposes.
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