Special Purpose District Notification Form - South Carolina Secretary Of State
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1
2
3SOUTH CAROLINA
SECRETARY OF STATE
MUNICIPALITIES DIVISION
SPECIAL PURPOSE DISTRICT NOTIFICATION FORM
Filing Instructions
st
Every Special Purpose District must submit this form to the Secretary of State by December 31
of
every even numbered year. Failure to file this form could lead to a declaration that the special purpose
district is inactive and a suspension of county funding to the district.
Please contact our office with any questions regarding this form at 803-734-1790 or email
spd@sos.sc.gov.
We do not accept this filing by fax or email; you may deliver by hand or mail to South Carolina
Secretary of State, Attn: Municipalities, 1205 Pendleton St., Suite 525, Columbia, SC 29201.
Please type or print clearly.
____________________________________________________________________
__________
Legal Name of Special Purpose District
SPD#
1. Physical address: _________________________________________________________________
Street Address, City, State, Zip Code
2. If you do not have a physical address, please provide the name, address and telephone number of your
registered agent:
_________________________________________
Registered Agent Name
__________________________________________________________________________________________
Street Address, City, State, Zip Code
3. Person completing this form:
__________________________ ________________ _____________________________
Name
Phone
Email
__________________________________________________________________________________________
Address, City, State, Zip Code
4. Describe services provided:
________________________________________________________________________________
5. Tax rate or fee charged (attach a separate sheet if necessary):
_________________________________________________________________________________
6. Date the Act or Ordinance passed that created your special purpose district: ____________________
Special Purpose District Notification Form, revised August 2012
Page 1 of 3
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