Form Abl-501 - Notification Of Deceased Licensee printable pdf download

Form Abl-501 - Notification Of Deceased Licensee

STATE OF SOUTH CAROLINA

1350

DEPARTMENT OF REVENUE

ABL-501

(Rev. 7/31/08)

NOTIFICATION OF DECEASED LICENSEE

4271

MAIL TO: SC Department of Revenue, ABL Section, Columbia, SC 29214-0907.

Telephone: (803) 898-5864

File with this form: a copy of the death certificate and a copy of your appointment by the probate court.

The below is to be completed by the Administrator, Executor, Executrix, or Personal Representative:

Name

Date of Birth

Social Security Number

Telephone Number

Home Address

City

County

Zip Code

Licensee and/or permittee information:

Name of deceased licensee and/or permittee (please list name as it appears on current license/permit)

Name of business (as it appears on current license/permit)

Business address (as it appears on current license/permit)

City

County

Zip Code

Current license and/or permit number(s)

If more than one license and/or permit is affected, please indicate below and file additional copies of this form for each

license/permit. You may make copies of this form to submit for other licenses/permits held.

Additional licenses/permits

Yes

Sworn to and subscribed before me

this

day of

year of

Notary Public for South Carolina

Signature of Administrator, Executor, Executrix,

or Personal Representative

My Commission Expires

NOTE: This license change is valid until deceased's estate is probated. Individual must file new application at

that time.

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Form Abl-501 - Notification Of Deceased Licensee