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12. Line 10 minus line 11 ……………………………………………………………………….. 12. $

(Income tax liability reduced by new jobs credits)

13. Line 9 minus line 11 …………………………………………………………………………. 13. $

(Unused new jobs credits may be carried forward 15 years.)

14. Amount of capital investment credits carried forward from prior years ………………... 14. $

(Unused capital investment credits may be carried forward indefinitely.)

15. Amount of line 14 used against current year income tax ……………………………….. 15. $

(Capital investment credit carried forward for more than 10 years may not reduce a

taxpayer's income tax liability by more than 25%. Capital investment credit carried

forward for 10 years or less may not reduce a taxpayer's income tax liability by more

than 50%. You may be able to enter a smaller amount under appropriate

circumstances. See line 11.)

16. Line 12 minus line 15 ……………………………………………………………………….. 16. $

(Income tax liability reduced by capital investment credits carried forward from prior years)

17. Amount of capital investment credit earned in current year ………….…………………. 17. $

18. Amount of line 17 used against current year income tax ……………………………….. 18. $

19. Add lines 14 and 17 …………………………………………………………………………. 19. $

(Total capital investment credits)

20. Add lines 15 and 18 …………………………………………………………………………. 20. $

(Total capital investment credits used against current year income tax)

21. Line 19 minus line 20 ………………………………………………………………………... 21. $

(Capital investment credits carried forward. Unused capital investment credit may be

carried forward indefinitely.)

INCOME TAX RETURN AFFIDAVIT OF COMPLIANCE AND WAIVER OF LIMITATIONS PERIOD

(Must accompany each tax return on which credit is claimed or used)

I hereby attest that the taxpayer: (1) has invested Two Hundred Million ($200,000,000.00) dollars of the Four Hundred

Million ($400,000,000.00) dollar investment required by SC Code Ann. Section 12-14-80(A)(2)(c); (2) has filed a

statement with the department stating that it commits to: (a) invest a total of Four Hundred Million ($400,000,000.00)

dollars in this State between September 1, 2011 and January 1, 2022; and (b) employ a total of One Thousand, Two

Hundred (1,200) full-time employees in this state by January 1, 2022; and (3) shall refund any credit received with interest

at the rate provided for underpayments of tax if the taxpayer fails to meet the requirement of Section 12-14-80(A)(2)(b) or

(c). Also, pursuant to Section 12-14-80(I), I hereby waive the statute of limitations as provided in Section 12-54-85,

allowing the department to assess the tax for a period commencing with the date that the return on which the credit is

claimed is filed and ending three years after the taxpayer notifies the department that the full Four Hundred Million

($400,000,000.00) dollar investment has been made.

Name (PLEASE PRINT)

Signature

This Affidavit and Waiver must be signed either by the taxpayer or someone authorized to sign on behalf of the taxpayer.

Date

Relation to Taxpayer

III. NEW JOBS AND CAPITAL INVESTMENT CREDITS APPLIE AGAINST WITHHOLDING TAX (begins next page)

36162014

Form Sch-Tc-11a - New Jobs And Capital Investment Credits For Plastics And Rubber Manufacturers Page 2