Form Abl 946r - Consent And Waiver Revocation
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1STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
ABL 946R
(Rev. 11/19/13)
CONSENT AND WAIVER REVOCATION
4426
Name of Sole Proprietorship, Corporation, LLC, etc.
FEIN/SSN
Name
Home Address
City
State
Zip
Yr/Mo/Date of SC Residency
Date of Birth
Social Security No.
Federal Employer Identification No.
Reason for Revocation of Consent (Check One):
No longer associated with business
I withdraw my consent
I, hereby, tender this revocation of Consent and Waiver. I understand this does not release me from any tax obligations I have
with the State of South Carolina. I also understand that my prior Consent and Waiver by this action is now void. I understand
that this Revocation may cause delay in the renewal of my license and/or permit, until an updated ABL-946 Consent and
Waiver form is provided to the Department of Revenue.
Principal/Type: (Number listed below)
% of ownership
Principal Types:
1. The owner (if sole proprietorship);
2. All officers of the business or entity which owns the business;
3. All partners (limited partners that cannot exercise management control need not sign);
4. All persons who own twenty-five percent (25%) or more of the value of the business entity;
5. All persons who own twenty-five percent (25%) or more of the combined voting power of the business or entity;
6. Managers of a limited liability company which is managed by managers;
7. Members of a limited liability company which is not managed by managers;
8. Any fiduciary who manages, controls title, or is otherwise in control of the business;
9. All employees who will have day-to-day operational management responsibility for the business or entity; and,
10. If a publicly traded corporation, the designated license holder (designated agent) (must be over 21 and a resident of S.C.).
11. All other principals must be listed also. If not a publicly traded corporation, list all stockholders.
12. If a nonprofit organization, list all officers and directors of the organization.
SWORN to and subscribed before me this
day of
, year of
Taxpayer's Signature
Notary Public for
My Commission Expires:
Notary (L.S.)
Taxpayer's Printed Name
Notary (printed name)
44261014
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