Fillable Form C-530 - Request For Penalty Waiver (Page 2 of 2) in pdf

Form C-530 - Request For Penalty Waiver Page 2

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Section III:

Signatures

If you file a joint tax return, both you and your spouse must sign. If the penalty waiver request is for a corporation, it must

include the corporation's name followed by the signature and title of the corporate officer authorized to sign.

I declare that this return and all attachments are true, correct and complete to the best of my knowledge and belief.

Taxpayer's Signature

Date

Spouse's Signature

Date

Business Entity Name (if applicable)

Title

Signature of Owner/Partner/Officer/LLC Member

Print Name

Date

Representative: You may request a penalty waiver on behalf of another taxpayer if you meet the requirements of S.C.

Code § 12-60-90(C) and if the request for penalty waiver includes a form SC2848 completed and signed by the taxpayer.

Form SC2848 can be found on our website at under Forms and Instructions > Other Forms. Taxpayers

representing themselves do not need to submit a form SC2848.

Representative's Signature

Representative's Printed Name

Telephone

Date

Social Security Privacy Act Disclosure

It is mandatory that you provide your social security number on this tax form. 42 U.S.C 405(c)(2)(C)(i) permits a state to use an

individual's social security number as means of identification in administration of any tax. SC Regulation 117-201 mandates that any

person required to make a return to the SC Department of Revenue shall provide identifying numbers, as prescribed, for securing

proper identification. Your social security number is used for identification purposes.

The Family Privacy Protection Act

Under the Family Privacy Protection Act, the collection of personal information from citizens by the Department of Revenue is limited to

the information necessary for the Department to fulfill its statutory duties. In most instances, once this information is collected by the

Department, it is protected by law from public disclosure. In those situations where public disclosure is not prohibited, the Family

Privacy Protection Act prevents such information from being used by third parties for commercial solicitation purposes.

64062011

Form C-530 - Request For Penalty Waiver Page 2

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