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SC TC-11A-WH4

1350

STATE OF SOUTH CAROLINA

(Rev. 2/6/13)

DEPARTMENT OF REVENUE

NEW JOBS AND CAPITAL INVESTMENT

3667

CREDITS FOR PLASTICS AND RUBBER

(Continues from 3rd Quarter

MANUFACTURERS

withholding tax return for the

Attach to your Fourth Quarter Withholding Tax Return

same tax year)

SSN or FEIN

Name As Shown On Tax Return

Name of SC counties where qualifying property is placed in service

SC Withholding File No.

Complete SC TC-11A-WH4 and file with the 4th Quarter withholding tax return in order to apply capital investment credits pursuant to

Code Section 12-14-80 and job tax credits against 4th Quarter withholding tax.

NOTE: Line numbers continue from TC-11A-WH3.

D. Fourth Quarter Withholding

43. Amount of unused new jobs credits available for carryforward ..……………………….. 43. $

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

44. Amount of unused capital investment credits carried forward from prior years ……..… 44. $

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

45. Add lines 43 and 44 ..................................................................................................... 45. $

(Total new jobs and capital investment credits carried forward)

46. 4th Quarter withholding tax liability before applying other credits ................................ 46. $

47. Multiply line 46 by 50% (.50) ……………………………………………………………….. 47. $

(The combination of new jobs and capital investment credits may not reduce a

taxpayer's withholding tax liability by more than 50% before applying other credits.)

48. 4th Quarter Credit: Lesser of lines 45 and 47 ............................................................ 48. $

49. Line 45 minus line 48 ……………………………………………………………….……….. 49. $

(Balance of unused new jobs and capital investment credits)

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

36671014

Form Sch-Tc-11a - New Jobs And Capital Investment Credits For Plastics And Rubber Manufacturers Page 6

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