Form Sc Sch.tc-57a - Application For Parental Refundable Credit - South Carolina Department Of Revenue

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1350
STATE OF SOUTH CAROLINA
SC SCH.TC-57A
DEPARTMENT OF REVENUE
(Rev. 7/1/16)
APPLICATION FOR
3656
PARENTAL REFUNDABLE CREDIT
20
Name(s) As Shown On Tax Return
SSN or FEIN
Spouse Name (if Co-Contributor)
SSN
Address
Phone
City County State Zip
Email
Parental Refundable Credit (Tuition Payment(s) to Eligible Schools for Exceptional Needs Children)
YES
NO
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?
YES
NO
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).
Payment Date
Eligible School
Qualifying Student
Tuition Payment Amount
(MMDDYY)
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
DATE
SPOUSE'S SIGNATURE (IF APPLICABLE)
DATE
SIGN
HERE
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 taxtech@dor.sc.gov.
36561017

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