Form I-338 - Composite Return Affidavit

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1350
STATE OF SOUTH CAROLINA
I-338
DEPARTMENT OF REVENUE
(Rev. 8/9/12)
COMPOSITE RETURN
3418
AFFIDAVIT
20
The undersigned taxpayer on oath, being first duly sworn, hereby certifies and agrees as follows:
I am a nonresident partner, shareholder of an S-Corporation, or member of a limited liability company (LLC).
1.
My name is:
My address is:
2.
(number and street)
(city, state, and zip code)
My social security number or federal employer identification number (FEIN) is:
The type of income for which this affidavit and agreement applies is:
3.
Distributed or undistributed South Carolina income from a partnership.
Distributed or undistributed South Carolina income from an S-Corporation.
Distributed or undistributed South Carolina income from a Limited Liability Company
taxed as a partnership.
Distributed or undistributed South Carolina income from a Limited Liability Company
taxed as an S-Corporation.
The name of the entity described in Question 3:
4.
The entity's address:
(number and street)
(city, state, and zip code)
The entity's federal employer identification number (FEIN):
I have no source of income taxable to South Carolina other than from the entity named in Question 4.
5.
This affidavit applies for the year January 1 - December 31, _______________ , or for the fiscal tax year
6.
beginning ________________________________ and ending ________________________________ .
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 agreement and, to the best of my knowledge and belief, it is true, correct and complete.
(Seal)
(Signature of partner, shareholder or LLC)
(Date)
(Name - Please print)
34181024

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