Form I-312 - Nonresident Taxpayer Registration Affidavit Income Tax Withholding
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1
2STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
I-312
NONRESIDENT TAXPAYER REGISTRATION
(Rev. 4/27/10)
AFFIDAVIT INCOME TAX WITHHOLDING
3323
Mail to: The company or individual you are contracting with.
The undersigned nonresident taxpayer on oath, being first duly sworn, hereby certifies as follows:
1.
Name of Nonresident Taxpayer:
2.
Trade Name, if applicable (doing business as):
3.
Mailing Address:
4.
Federal Employer Identification Number (FEIN):
5.
Hiring or Contracting with:
Name:
Address:
Receiving Rentals or Royalties From:
Name:
Address:
Beneficiary of Trusts and Estates:
Name:
Address:
6.
I hereby certify that the above named nonresident taxpayer is currently registered with (check the appropriate box):
The South Carolina Secretary of State or
The South Carolina Department of Revenue
Date of Registration:
7.
I understand that by this registration, the above named nonresident taxpayer has agreed to be subject to the jurisdiction
of the South Carolina Department of Revenue and the courts of South Carolina to determine its South Carolina tax
liability, including estimated taxes, together with any related interest and penalties.
8.
I understand the South Carolina Department of Revenue may revoke the withholding exemption granted under Code
Sections 12-8-550 (temporarily doing business or professional services in South Carolina), 12-8-540 (rentals), and
12-8-570 (distributions to nonresident beneficiary by trusts or estates) at any time it determines that the above named
nonresident taxpayer is not cooperating with the Department in the determination of its correct South Carolina tax
liability.
The undersigned understands that any false statement contained herein could be punished by fine, imprisonment or both.
Recognizing that I am subject to the criminal penalties under Code Section 12-54-44 (B) (6) (a) (i), I declare that I have
examined this affidavit and to the best of my knowledge and belief, it is true, correct and complete.
(Seal)
Signature of Nonresident Taxpayer (Owner, Partner or Corporate Officer, when relevant)
Date
If Corporate officer, state title:
(Name - Please Print)
33231028
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