Form Sc616 - Certification Of Eligibility For South Carolina New Jobs Tax Credit - 2009
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2STATE OF SOUTH CAROLINA
STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
DEPARTMENT OF REVENUE
SC616
CERTIFICATION OF ELIGIBILITY FOR
(Rev. 4/2/09)
SOUTH CAROLINA NEW JOBS TAX CREDIT
3068
1. Name of Taxpayer:
FEIN
2. Mailing Address:
3. Name of county in which significant expansion is planned:
4. Number of new full time jobs to be created:
5. Year in which expansion is planned:
6. Type of business: (Use attachment if necessary.)
7. Application is hereby made to the SC Department of Revenue for certification that
County for the purposes of this expansion
is designated as:
distressed county
least developed county
under developed county
moderately developed county
developed county
(check one of the above.)
Date
Name of Taxpayer
Signature of Officer (or other appropriate official)
Mail To:
SC Department of Revenue
Print Officer's Name
Research & Review
Columbia, SC 29214-0019
Title
Retain a copy for your records
30681027
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