Form St-10-G - Application For Exemption For Federal Government Contract printable pdf download

Form St-10-G - Application For Exemption For Federal Government Contract

STATE OF SOUTH CAROLINA

1350

DEPARTMENT OF REVENUE

ST-10-G

APPLICATION FOR EXEMPTION FOR FEDERAL GOVERNMENT CONTRACT

(Rev. 8/18/08)

Mail to: SC Department of Revenue, License and Registration,

5085

Columbia, SC 29214-0140

SC Code Section 12-36-2120 (29)

Name of Contractor :

(Who has a written contract with federal government.)

Office Location of Contractor:

Mailing Address of Contractor:

(

)

Telephone Number :

FEI Number or SSN:

Please provide Project information.

Project Name:

Project Number:

Building Permit or Other Identifying Number:

(If no number, enter "NA".)

(If known.)

Project Location:

Expected Project Completion Date:

A COPY OF THE CONTRACT FOR WHICH AN EXEMPTION CERTIFICATE IS BEING REQUESTED MUST BE

SUBMITTED WITH THIS APPLICATION.

Please read the following statement and sign where indicated.

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.

Signing for Construction Co.

Title (Corp. Officer, Gen. Ptr., Owner)

Print Name

Date Signed

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.

50851021

Form St-10-G - Application For Exemption For Federal Government Contract

Related Articles

Related forms

Related Categories