Form St-429 - Drycleaning Facility Surcharge Return printable pdf download

Form St-429 - Drycleaning Facility Surcharge Return

STATE OF SOUTH CAROLINA

1350

DEPARTMENT OF REVENUE

ST-429

DRYCLEANING FACILITY SURCHARGE RETURN

(Rev. 7/24/14)

Mail to: SC Department of Revenue, Drycleaning Surcharge,

5134

Columbia, SC 29214-0103

Registration Number

LOCATION ADDRESS

FEIN

MAILING ADDRESS

SID

Period Covered

File Return On or By

Gross Proceeds of Sales...................................................................................

Surcharge Rate.................................................................................................

.01

Total Surcharge Due.........................................................................................

Penalty

Interest

Total Amount Due (Add Lines 3 and 4)..............................................................

34-3522

For Office Use Only

Returns are due on or before the 20th day of the month following the

DUE DATE:

close of the period covered.

Important - Return becomes DELINQUENT if it is postmarked after the 20th day (return with payment due on or before

the 20th) following the close of the period.

For answers to questions pertaining to completing this form, please call (803) 898-5000.

I hereby certify that the information contained in this report (including accompanying schedules and

statements) has been examined by me and to the best of my knowledge is correct and complete.

Signature

Title

Name (Print)

Email Address

Date

Phone Number

51341030

Form St-429 - Drycleaning Facility Surcharge Return