STAPLE

13.

If I have filed a balance due return, I understand that if the SC Department of Revenue does not receive full and timely payment of my tax liability, I will

Sign Here

I consent  that my refund be directly depositedas 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)              DateYour signature                                                               Date

Paid

Preparer's

Use

Only

Tax Year

Spouse's  social security number

Your social security numberYour 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 IIDirect Deposit of Refund or EFW Payment of Tax Due(Optional - See instructions.)

Part III

Preparersignature

00

1

2

5

3

4

00

00

00

00

The first two numbers of the RTN mustbe 01 through 12 or 21 through 32.

10. Bank account number (BAN)

Date

Check ifalso paid

preparer

Checkif self-

employed

PTIN

Firm name (oryours if self-employed)

and addressZIP code

I declare that I have compared the information (including direct deposit or EFW data) on my return withthe information I have provided to my electronicreturn originator (ERO) and the amounts agreewith 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 schedules and statements be sent to the Internal Revenue Service (IRS) by my ERO, and subsequently bythe 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

DateCheck ifself-

employed

ZIP code

PTINERO

signature

Firm name (oryours 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 account designated in Part II for payment of my South Carolina taxes owed, and (2) my financial

institution to debit the entry to my account. I also authorize the financial institutions involvedin the processing of my electronic payment of

Revenue no later than two business days priorto the withdrawal (settlement) date by calling 803-896-1715.

I declare that I have received the above taxpayer's return and the entrieson this form are complete and correct to the best of my knowledge. I haveobtained the taxpayer's signature on this form before 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 Departmentof Revenue, and have followed all other requirements described in the IRSPub. 1345 Authorized IRS e-file Providers of Individual Income Tax Returns, 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 andthey  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.

13501350STATE 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 thisauthorization, 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) 

 HEREand 1099(s)

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