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Section C: Withholding Tax

Every employer having employees earning wages in SC must register for withholding. Other types of payments also

require state tax withholding. See instructions for more information.

20. Check the box that applies to your business:

02 Resident business: Principal place of business is inside South Carolina.

05 Nonresident Business: Principal place of business is outside of South Carolina .

21. Filing Frequency:

Quarterly: Returns must be filed every quarter.

01 Annual: All employees are household employees, farmers, fishermen or ministers. Returns are filed at the

end of each calendar year.

22. Anticipated Date of First Payroll (mm/dd/yyyy):

This date will be used as the open date of your withholding account, and returns must be filed beginning with this

date regardless of activity.

Section D: Nonresident Withholding Exemption

Check the appropriate block to administratively register with the Department and claim exemption from nonresident withholding

required by SC Code Sections 12-8-540 (rents and royalties), 12-8-550 (temporarily doing business or performing services in SC),

or 12-8-570 (trust or estate beneficiaries). The exempt person agrees to be subject to the jurisdiction of the Department and the

SC courts to determine SC tax liability, including withholding, estimated taxes, and interest and penalties, if any. Registering is not

an admission of tax liability, and, does not, by itself, require the filing of a tax return.

See instructions for further information.

Main Business:

I agree to file SC tax return

I am not subject to SC Tax Jurisdiction (no NEXUS)

Section E: Name(s) of Business Owner, General Partners, Officers, or Members

Social Security Number

Name/Title/General Partners

Home Address

% Ownership

Social Security Privacy Act

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 117-1 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.

Upon completion of both pages, sign and date the application below.

I certify that all information on this application, including any attachments, is true and correct to the best of my knowledge.

SIGNATURE OF OWNER, ALL PARTNERS, OR CORPORATE OFFICER

TITLE

DATE

MAIL TO: SC DEPARTMENT OF REVENUE

REGISTRATION UNIT

COLUMBIA, SOUTH CAROLINA 29214-0140

If you have questions about this form, please call (803) 896-1350.

80482011

Form Scdor-111 - South Carolina Department Of Revenue Tax Registration Application - 2013 Page 2