Form Sc616 - South Carolina Notification To Lock In County Designation
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2STATE OF SOUTH CAROLINA
STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
DEPARTMENT OF REVENUE
SC616
NOTIFICATION TO LOCK IN
(Rev. 8/30/11)
COUNTY DESIGNATION
3068
1. Name of Taxpayer:
2. FEIN or SSN:
3. Mailing Address:
4. Name of county in which jobs will be created:
5. Number of new full time jobs to be created:
6. Year in which expansion is planned:
7. Type of business (Use attachment if necessary):
8. Notification is hereby made to the SC Department of Revenue that the county named on line 4 is designated as:
Tier IV
Tier III
Tier II
(check one of the above.)
Date
Name of Taxpayer
Signature of Officer (or other appropriate official)
Mail To:
SC Department of Revenue
Print Officer's Name
Research & Review
Columbia, SC 29214-0019
Title
Retain a copy for your records
30681027
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