Form C-245 - Application For Appeal And/or Protest Pursuant To Revenue Procedures Act
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1350
1350
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
Application for Appeal and/or
C-245
Protest Pursuant to Revenue Procedures Act
(Rev. 2/19/14)
6177
S S
S.C. Code Ann.
12-60-10, et seq.
Use this form to state why you disagree with the notice you received. Call the telephone number on the notice for
questions concerning this matter. Return this document to the Department of Revenue address shown on the notice or
document with which you disagree.
Do not submit this form if:
You are appealing the seizure of your state refund for a debt such as a Hospital Bill, Child Support, Student Loan,
etc. Contact the claimant agency to which the refund was applied.
You are unable to pay the proposed amount. Call the telephone number on the notice or document you received for
payment information.
Section I:
Taxpayer Identification
Taxpayer Name(s):
(Please type or print)
Mailing Address:
City:
State:
Zip Code:
Telephone:
Period(s) Covered:
Type(s) of Tax(es) or matter. Check all that apply:
Corporate Income Tax
Employer Withholding Tax
Individual Income Tax
Liquor by the Drink Tax
Motor Fuel Tax
Partnership Income Tax
Regulatory Violation
Sales and Use Tax
Tobacco Tax
Other (Specify)
Identification Number (Social Security Number, License Number, File Number, etc.):
Section II:
Department of Revenue Document to be Attached
Attach a copy of the Department of Revenue document or notice you received which led to the filing of this protest.
61772028
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