Sc Sch.tc-56a - Application For Angel Investor Credit

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1350
1350
STATE OF SOUTH CAROLINA
SC SCH.TC-56A
DEPARTMENT OF REVENUE
(Rev. 10/18/13)
APPLICATION FOR
3658
ANGEL INVESTOR CREDIT
20
Name(s) As Shown On Tax Return
SSN or FEIN
Mailing Address
Contact Person
Street
Contact Person's Title
City
County
State
ZIP
Telephone Number
Physical Address
Street
Fax Number
City
County
State
ZIP
Email
If the applicant is a pass-through entity, attach a separate sheet that lists all the owners, their social security numbers, the
percent ownership, and their addresses.
Are you an accredited investor as defined by the U.S. Securities and Exchange Commission?
Yes
No
See instructions. If you answered NO, STOP. You do not qualify for this credit.
Enter each date on which you made a qualified investment in a qualified business during the tax year, the amount of the
qualified contribution, and the named of the qualified business (Attach a separate sheet if necessary.):
$
Date of Investment
Qualified Investment
Name of Qualified Business
$
Date of Investment
Qualified Investment
Name of Qualified Business
$
Date of Investment
Qualified Investment
Name of Qualified Business
$
Total qualified investment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date
Signature of Taxpayer or Officer
Printed Name of Taxpayer or Officer
Mail To:
SC Department of Revenue
Research and Review
Columbia, SC 29214-0019
Title, If Applicable
OR
Email a scanned PDF of TC-56A to
36581015

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