Form L-2147 - Fair Bingo Return

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STATE OF SOUTH CAROLINA
L-2147
DEPARTMENT OF REVENUE
(Rev. 7/5/07)
FAIR BINGO RETURN
4238
EFT
REPORT THIS NUMBER WHEN WRITING
Mail to: SC Department of Revenue, Regulatory Division, Bingo Enforcement,
THE SC DEPARTMENT OF REVENUE
Columbia, SC 29214-0134. Telephone (803) 898-5393
LICENSE NO.
IMPORTANT: This return is due on the 1st day after the fair closes.
Name of Taxpayer
Month Ending
Mailing Address
FED. E.I./Social Security No.
City
State
Fair Location
FOR OFFICE USE ONLY
(1)
Total Face Value of Cards Purchased
(2)
Bingo Tax Rate
10%
(3)
Tax Due: (Line 1 X 2)
(4)
Penalty
(5)
Interest
(6)
Total Penalty and Interest (Line 4 + 5)
14-2564
(7)
Total Tax, Penalty and Interest (Line 3 + 6)
I certify that this return, including the accompanying schedules or statements, has been examined by me and is to the
best of my knowledge and belief, a true and complete return, made in good faith, for the period stated pursuant to the
provision of the Code of Laws 1976 and Acts Amendatory Thereto.
Signature
Title of Preparer
Date
Return must be signed by authorized person of corporation. For questions pertaining to filing this form call (803) 898-5393.
SEE THAT LICENSE NUMBER IS ON RETURN.
42381020

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