STAPLE 13. If I have filed a balance due return, I understand that if the SC Department of Re venue does not receive full and timely payment of my tax liability, I will Sign Here I consent that my refund be directly deposited as designated in Part II, and declare that the information shown on lines 1 through 8 is Declaration of Taxpayer (Sign only after Part I is completed.) Spouse's signature (If joint, BOTH must sign) Date Your signature Date Paid Preparer's Use Only Tax Year Spouse's social security number Your social security number Your first name and initial Last name Daytime telephone # 9. Routing transit number (RTN) Home address (number and street, apt. number or RR) City, town or post office, state and ZIP code Please print or type. 2. Net SC tax (SC1040, line 15). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Tuition Tax Credit (SC1040, line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If joint return, spouse's first name and initial Last name, if different Part IV 8. Amount you owe (SC1040, line 34) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (See Instructions.) 1. Federal taxable income ( SC1040, line 1). ................................................. Tax Return Information (Whole dollars only) Part I Part II Direct Deposit of Refund or EFW Payment of Tax Due (Optional - See instructions.) Part III Preparer signature 00 1 2 5 3 4 00 00 00 00 The first two numbers of the RTN must be 01 through 12 or 21 through 32. 10. Bank account number (BAN) Date Check if also paid preparer Check if self- employed PTIN Firm name (or yours if self-employed) and address ZIP code I declare that I have compared the information (inc luding direct deposit or EFW data) on my return with the information I have provided to my electronic return originator (ERO) and the amounts agree with the amounts on my SC tax return. To the best of my knowledge, my return is true and complete. I consent that my return and accompanying schedul es and statements be sent to the Internal Rev enue Service (IRS) by my ERO, and subsequently by the IRS to the SC Department of Revenue. Do not submit this form to the SC Department of Revenue. Keep with your records. ERO's Use Only Date Check if self- employed ZIP code PTIN ERO signature Firm name (or yours if self-employed) and address D O N O T M A I L K E E P F O R Y O U R R E C O R D S 7. Refund (SC1040, line 30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 00 a. 3. Use Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 4. Total Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 00 12. Withdrawal Date Withdrawal Amount $ e an Electronic Funds Withdrawal (payment) entry to my financial institution a ccount designated in Part II for payment of my S outh Carolina taxes owed, and (2) my financial institution to debit the entry to my account. I al so authorize the financial institutions involved in the processing of my electronic payment of Revenue no later than two business days prior to the withdrawal (settl ement) date by calling 803-896-1715. I declare that I have received the above taxpayer's return and the entries on this form are complete and correct to the best of my knowledge. I have obtained the taxpayer's signature on this form bef ore submitting this return to the SC Department of Revenue. I have provided the taxpayer with a copy of all forms and information to be filed with the IRS and the SC Department of Revenue, and have followed all other requirements described in the IRS Pub. 1345 Authorized IRS e-file Providers of Individual Income Tax Retur ns, and requirements specified by the SC Department of Revenue. If I am the preparer, I declare that I have examined the above taxpayer's return and they are true and complete. This declaration is based on all information of which I have knowledge. I understand I do not mail this form. I am required to keep this form and the supporting documents for three (3) years. 1350 1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE (Rev. 7/23/10) 3299 INDIVIDUAL INCOME TAX DECLARATION FOR ELECTRONIC FILING SC8453 FEIN FEIN 5. SC Income Tax Withheld (SC1040, lines 16 & 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Type of account: Checking Savings correct. If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund. b. I authorize (1) the South Carolina Department of Revenue and its designated financial agents to initiat taxes to receive confidential information necessary to answer inquiries and resolve issues related to my payment. Under the items of this authorization, I can revoke this authorization by notifying the South Carolina Department of remain liable for the tax liability and all applicable interest and penalties. Declaration of Electronic Return Originator (ERO) and Paid Preparer accompanying schedules and statements, and to the best of my knowledge, COPIES OF STATE W-2(s) HERE and 1099(s) ----------------Page (0) Break----------------