Form L-2090 - Affidavit Of Exemption Soft Drinks License Tax

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STATE OF SOUTH CAROLINA
L-2090
DEPARTMENT OF REVENUE
AFFIDAVIT OF EXEMPTION
(Rev. 3/98)
SOFT DRINKS LICENSE TAX
4175
STATE OF
COUNTY OF
Personally appeared
who being first duly sworn, deposes and says:
That he is the
of
That the company is
with its principal office or place of
business at
That this affidavit is made for the purpose of claiming an exemption from South Carolina Soft Drinks License Taxes. That
said
, for which exemption is hereby claimed,
is a
drink and that it contains thirty per cent or more, by volume of natural fruit or
natural vegetable juice, or thirty per cent or more, of natural liquid milk. That is understood that the terms "natural fruit" or
"natural vegetable juices" means the original resultant liquid resulting from the reconstitution of natural fruit or natural
vegetable juice concentrate, to wit: the restoration of water to dehydrated natural fruit or natural vegetable juices. The
term "natural liquid milk" shall mean natural liquid milk regardless of butterfat content or shall mean reconstituted natural
milk concentrate regardless of butterfat content, to wit: the restoration of water to dehydrated natural milk.
It is understood that the exemption from the tax shall not apply to any fruit or vegetable juice drink to which is added any
one or more of the following, that is, any coloring, artificial flavoring, or preservative. Sugar or salt or vitamins shall not
be construed as an artificial flavor or preservative.
Pursuant to Section 12-21-1900 of 1976, South Carolina code as amended the affiant declares that the formula for this
bottled soft drink as used therein is as follows:
Ingredient
Volume
(List ingredients by name and volume)
(Signature)
(Title)
Subscribed and sworn to before me
Mail to:
South Carolina Department of Revenue
this
day of
19
.
Registration Unit
Columbia, South Carolina 29214-0140
Telephone: (803) 898-5872
(Notary Public)
NOTE: A separate affidavit must be submitted for each product and label(s) must be attached to each affidavit.

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