Form Sctc 111 – Fill Out and Use This PDF

TAXES TO BE REGISTERED FOR THIS BUSINESS LOCATION

WITHHOLDING (complete section A)

SALES (complete section C; $50.00 license tax is required)

Nonresident Withholding Exemption (complete section B)

PURCHASER'S CERTIFICATE ( complete section D)

COMPLETE BOTH SIDES OF THIS APPLICATION

PLEASE PRINT OR TYPE ALL INFORMATION

1.

OWNER, PARTNERSHIP, OR CORPORATE CHARTER NAME

2. TRADE NAME (DOING BUSINESS AS)

3. PHYSICAL LOCATION OF BUSINESS REQUIRED (NO P.O. BOX)

4.

BUSINESS PHONE NUMBER

DAYTIME PHONE NUMBER

STREET

5.

FEDERAL IDENTIFICATION NUMBER

CITY

COUNTY (REQUIRED)

STATE

ZIP

7.

TYPE OF BUSINESS

AGRICULTURE, FORESTRY, FISHING

PROFESSIONAL, SCIENTIFIC,

6. MAILING ADDRESS (FOR ALL CORRESPONDENCE)

& HUNTING (11)

& TECHNICAL SERVICES (54)

MINING (21)

MANAGEMENT OF COMPANIES

IN CARE OF

UTILITIES (22)

& ENTERPRISES (55)

CONSTRUCTION (23)

ADMINISTRATIVE AND SUPPORT, WASTE

MANUFACTURING (31 -33)

MANAGEMENT & REMEDIATION SERVICES (56)

STREET

WHOLESALE TRADE (41-43)

EDUCATION SERVICES (61)

RETAIL TRADE (44-46)

HEALTH CARE & SOCIAL ASSISTANCE (62)

TRANSPORTATION &

ARTS, ENTERTAINMENT, & RECREATION (71)

CITY

COUNTY

STATE

ZIP

WAREHOUSE (48-49)

ACCOMMODATION & FOOD SERVICES (72)

9.

LOCATION OF RECORDS (NO P.O. BOX)

INFORMATION (51)

OTHER SERVICES (81)

FINANCE & INSURANCE (52)

PUBLIC ADMINISTRATION (91-93)

REAL ESTATE, RENTAL & LEASING (53)

10. TYPE OF OWNERSHIP

SOLE PROPRIETOR (one owner)

8. MAIN BUSINESS (I.E., RETAIL FURNITURE SALES)

PARTNERSHIP (two or more owners, other than LLP)

LLC/LLP FILING AS

SC CORPORATION DATE INC.

8A.

CHECK IF YOU SELL THESE PRODUCTS (for Solid Waste Purposes):

FOREIGN CORPORATION (ATTACH COPY OF ARTICLES OF CERTIFICATE OF AUTHORITY).

MOTOR OIL

LEAD ACID BATTERIES

TIRES

LARGE APPLIANCES

UNINCORPORATED ASSOCIATION; ENTER LEGAL NAME

8B.

DO YOU SELL AVIATION GASOLINE?

YES

NO

8C. DO YOU PROVIDE SERVICE TO CELLULAR AND PERSONAL

OTHER (EXPLAIN)

COMMUNICATIONS USERS?

YES

NO

11. NAME(S) OF BUSINESS OWNER, GENERAL PARTNERS, OFFICERS OR MEMBERS:

ARE YOU A SC RESIDENT? (Y/N) _______________________ HOW LONG HAVE YOU LIVED IN SC? _________________________ (YEARS, MONTHS)

	12. HAVE YOU:						D. FORMER OWNER'S S.C.E.S.C. ACCOUNT NUMBER:
	A. ACQUIRED ANOTHER BUSINESS?			YES	NO
	MERGED W ITH ANOTHER BUSINESS?			YES	NO
							FORMER OWNER'S S.C. TAX ACCOUNT NUMBER:
	FORMED A CORPORATION OR PARTNERSHIP			YES	NO
	MADE ANY OTHER CHANGE IN THE OWNERSHIP?			YES	NO
	B. DID YOU ACQUIRE: ALL OF THE SOUTH CAROLINA OPERATIONS?						E. NAME OF BUSINESS ACQUIRED:
	PART OF THE SOUTH CAROLINA OPERATIONS?
	PERCENTAGE ACQUIRED:
							(Full organization name including trade name)
							ADDRESS OF FORMER OWNER:
	C. DATE ACQUIRED OR CHANGED:
				YES	NO
	WAS THE BUSINESS OPERATING AT THE TIME OF ACQUISITION OR CHANGE?
	DATE CLOSED:
	DOES THE FORMER OWNER OR LEGAL ENTITY CONTINUE TO HAVE EMPLOYEE?			YES	NO

COMPLETE REVERSE SIDE OF THIS FORM

I CERTIFY THAT ALL INFORMATION ON THIS APPLICATION, INCLUDING ANY ATTACHMENTS, IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE

SIGNATURE OF OWNER, ALL PARTNERS, OR CORPORATE OFFICER

TITLE

DATE

SECTION A: TO APPLY FOR WITHHOLDING NUMBER Every employer having employees earning wages in SC must register for withholding. Other types of payments also require state tax withholding.

STATUS OF EMPLOYER (CHECK ONE):

RESIDENT - Principal place of activity inside SC

NONRESIDENT - Principal place of activity outside SC

CLASSIFICATION OF RESIDENT EMPLOYER (CHECK ONE):

01 Tax withheld from sources that do not require withholding (Ex.: Domestic Help, Farmers, Fishermen)

02 FEDERAL withholding (941 total) does not exceed $2,500.00 per quarter

03 FEDERAL withholding (941 total) is less than $50,000 during 12-month lookback period 04 FEDERAL withholding (941 total) is greater than $50,000 during 12-month lookback period

CLASSIFICATION OF NONRESIDENT EMPLOYER (CHECK ONE):

01 Tax withheld from sources that do not require withholding (Ex.: Domestic Help, Farmers, Fishermen)

05 SC State withholding is less than $500 per quarter 06 SC State withholding Totals $500 or more per quarter

SECTION B: EXEMPTION FROM WITHHOLDING ON NONRESIDENTS

Check the appropriate block to administratively register with the Department and claim exemption from nonresident withholding required by SC Code Sections 12-8-540 (rents and royalties), 12-8-550 (temporarily doing business or performing services in SC), or 12-8-570 (trust or estate beneficiaries). The exempt person agrees to be subject to the jurisdiction of the Department and the S.C. courts to determine S.C. tax liability, including withholding, estimated taxes, and interest and penalties, if any. Registering is not an admission of tax liability, and, does not, by itself, require the filing of a tax return.

See instructions for further information.

SECTION C: TO APPLY FOR RETAIL SALES LICENSE ($50.00 LICENSE TAX IS REQUIRED.)

In and out-of state sellers. A retail license will not be issued to a person with any outstanding state tax liability. Any license tax paid with this application will be applied to the tax liability.

If applying for Retail License, a $50.00 Sales License Tax is required with this application.

SECTION D: TO APPLY FOR PURCHASER'S CERTIFICATE OF REGISTRATION FOR USE TAX S. C. Use Tax is imposed on the storage, use, or consumption of tangible personal property on which S.C. sales tax has not been previously paid.

SECTION E: If mailing address for returns is different from front of application indicate type of tax this applies to.

IF CURRENTLY OR PREVIOUSLY REGISTERED WITH SC DEPARTMENT OF REVENUE UNDER THIS OWNERSHIP, INDICATE ACCOUNT NUMBER(S) IN THIS SPACE

NAME OF BANKING INSTITUTION USED

Enter Internet/E-mail address

UPON COMPLETION OF BOTH SIDES, SIGN AND DATE ON FRONT OF APPLICATION.

MAIL TO: SC DEPARTMENT OF REVENUE, REGISTRATION UNIT, COLUMBIA, SOUTH CAROLINA 29214-0140