Abl 920 Form – Fill Out and Use This PDF

Mail to: SCDOR, ABL Section, PO Box 125, Columbia, SC 29214-0907

Email: ABL@dor.sc.gov

Only Sole Proprietors must complete this form, as required by SC Code Section 8-29-10 and Title 61.

I,						of				,
		Print clearly first, middle, and last name							Home address (no PO box)
											,
		City				State			ZIP
being first duly sworn, deposes and state the following:
Name change/alias:			Yes	No	If yes, list:

Check ONLY one box: See Instructions and Definitions for accepted documents. Principals must be at least 21 years old.

1. I am a United States Citizen.

2. I am a Legal Permanent Resident.

3. I am a Qualified Alien under the Federal Immigration and Nationality Act, Public Law 82-44.

4. I am a Foreign Citizen, and resident of

Country of residency

Date of birth (mm/dd/yyyy)

Alien Registration number

YOU MUST ATTACH A COPY OF ALL IMMIGRATION DOCUMENTS

This affirmation must be completed by all sole proprietors, or the application will be denied. This affirmation will also apply during any renewal. Any change in immigration or citizenship status must immediately be reported to the SCDOR. Willfully making a false statement on this affirmation is a felony, punishable by fines and/or imprisonment.

Under penalty of perjury and recognizing that I am subject to the criminal and civil penalties imposed by Title 12 of the South Carolina Code of Laws, I declare that I have examined this affirmation and to the best of my knowledge and belief, it is true, correct, and complete.

I understand that a misstatement or concealment of fact in an application is sufficient grounds for the revocation of the license and/or permit. Under penalties of perjury, I declare that I have read and understood this form and the information I have provided herein is true, correct, and complete.

Principal's Signature

Date

43821024

Instructions and Definitions

Check box 1 –

If you are a US Citizen by birth or naturalization.

Check box 2 –

If you are a legal permanent resident and you are not a US citizen, but are residing in the US under legally recognized and lawfully recorded permanent residence as an immigrant.

PROVIDE A COPY OF ALL IMMIGRATION DOCUMENTS.

Check box 3 –

If you are a qualified alien. You are a qualified alien if you are:

•an alien who is lawfully admitted for permanent residence under the INA;

•an alien who is granted asylum under Section 208 of the INA;

•a refugee who is admitted to the United States under Section 207 of the INA;

•an alien who is paroled into the United States under Section 212(d)(5) of the INA for a period of at least 1 year;

•an alien whose deportation is being withheld under Section 243(h) of the INA (as in effect prior to April 1, 1977) or whose removal has been withheld under Section 241(b)(3);

•an alien who is granted conditional entry pursuant to Section 203(a)(7) of the INA as in effect prior to April 1, 1980;

•an alien who is a Cuban/Haitian Entrant as defined by Section 501(e) of the Refugee Education Assistance Act of 1980;

•an alien who has been battered or subjected to extreme cruelty, or whose child or parent has been battered or subject to extreme cruelty.

PROVIDE A COPY OF ALL IMMIGRATION DOCUMENTS.

Check box 4 –

If you are a non-immigrant alien who seeks temporary entry to the US for a specific purpose. You must have a permanent residence abroad (for most classes of admission) and qualify for the non-immigrant classification sought. The non-immigrant classifications include:

•foreign government officials,

•visitors for business and for pleasure,

•aliens in transit through the US,

•treaty traders and investors, students,

•international representatives,

•temporary workers and trainees,

•representatives of foreign information media,

•exchange visitors, fiancé(e)s of US citizens,

•intracompany transferees,

•NATO officials,

•religious workers, and some others.

Most nonimmigrants can be accompanied or joined by spouses and unmarried minors (or dependent) children.

PROVIDE A COPY OF ALL IMMIGRATION DOCUMENTS.

Accepted Immigration Documents:

•Unexpired Foreign passport with I-551 stamp or attached INS Form I-94 indicating unexpired employment authorization

•Alien Registration Receipt Card with photograph (INS Form I-151 or I-551)

•Unexpired Temporary Resident Card (INS Form I-688)

•Unexpired Employment Authorization Card (INS Form I-688)

•Unexpired Reentry Permit (INS Form I-327)

•Unexpired Refugee Travel Document (INS Form I-571)

•Unexpired Employment Authorization Document issued by the INS which contains a photograph (INS Form I-688B)

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