STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
PARENTAL REFUNDABLE CREDIT
Name(s) As Shown On Tax Return
SSN or FEIN
Spouse Name (if Co-Contributor)
City County State Zip
Parental Refundable Credit (Tuition Payment(s) to Eligible Schools for Exceptional Needs Children)
1. Are you an individual who has custody or care for a qualifying student enrolled in an eligible school?
2. Did you pay tuition to an eligible school for a qualifying student?
If you answered “NO” to either question, you do not qualify for the refundable educational credit.
3. What is the full cost of tuition for the entire school year?
4. Fill in the table below (attach another sheet for 3 or more payments).
Tuition Payment Amount
Date and Signature(s)
I certify that all information on this application, including any attachment is true and correct to the best of my knowledge.
TAXPAYER OR OFFICER'S SIGNATURE
SPOUSE'S SIGNATURE (IF APPLICABLE)
Mail to: SC Department of Revenue,
Attn: Parental Refundable
Credit, PO Box 125, Columbia, SC 29214 or
e-mail a pdf file of this application to email@example.com.