Form L-2140 - Motor Fuel Refund Registration
ADVERTISEMENT
1
21350
STATE OF SOUTH CAROLINA
L-2140
DEPARTMENT OF REVENUE
(12/21/07)
MOTOR FUEL REFUND REGISTRATION
4230
Provide all information requested. For assistance call (803) 896-1990.
SID #
Do you have South Carolina bulk storage of 1000 gallons or more for gasoline and/or
low sulfur diesel? Check one:
Yes
or
No
File #
Owner, Partnership, or Corporate Charter Name:
Trade Name (doing business as):
Physical Location of Business Required (No PO Box)
Mailing Address for all Correspondence
In care of
street
street
city
county (required)
state
ZIP
city
county (required)
state
ZIP
Federal Identification Number
Business Phone Number
Daytime Phone Number
Location of Records (no PO Box):
Type of Ownership - The Type of Ownership information is reqired. If sole proprietor, your Social Security number must be provided.
Sole Proprietor (one owner)
SC Corporation Date Inc.
General Partnership (two or more owners)
LLC/LLP Formation Date
Formation Date
Unincorporated Association; Enter legal name
Limited Partnership
Formation Date
Foreign Corporation
(Attach copy of articles or certificate of authority.)
Other (Explain)
Name(s) of business owner, partners, or officers:
If partner,
Social Security Number
Name/Title
Home Address
Percent Owned
When signing this form, it is important that the information contained in your report be correct and complete. To
wilfully furnish a false or fraudulent statement to the Department is a crime.
Signature
Title
Date
Mail this form to:
SC Department of Revenue, Motor Fuel, Columbia, SC 29214-0139
Office Use:
Approved by:
Date sent to License and Registration:
42301028
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial