Form Nx-100 - Questionnaire Regarding Activities In South Carolina printable pdf download

Form Nx-100 - Questionnaire Regarding Activities In South Carolina

STATE OF SOUTH CAROLINA

1350

DEPARTMENT OF REVENUE

NX-100

QUESTIONNAIRE REGARDING

(Rev. 5/23/12)

6342

ACTIVITIES IN SOUTH CAROLINA

Complete and return to: Nexus/Discovery Section, SC Dept. of Revenue, P.O. Box 125, Columbia, SC 29214

Visit us at for contact information.

PART 1 - GENERAL INFORMATION

Exact corporation name

Address of principal office

State and date of incorporation

Federal Identification Number

Have you ever filed returns with the South Carolina Department of Revenue? If yes, indicate years or periods in the

space below.

Yes

Periods

Corporation Income Tax

Sales/Use Tax

Withholding Tax

Highway Use Tax

Are you included in a consolidated South Carolina tax return?

Yes

If yes, indicate Parent

FEIN

Nature of business (products or service)

PART 2 - FINANCIAL INFORMATION

Amount of gross receipts derived from South Carolina customers (last three years)

List names and addresses of your three largest customers in South Carolina

*For additional information, visit us at .

63421012

Form Nx-100 - Questionnaire Regarding Activities In South Carolina