Form Sc3911 - Refund Tracer - South Carolina Department Of Revenue
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1SC3911
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
(Rev. 8/7/01)
REFUND TRACER
3101
PLEASE ALLOW AT LEAST TWELVE WEEKS TO PROCESS A RETURN BEFORE FILING THIS FORM!
YOUR FIRST NAME AND INITIAL
LAST NAME
YOUR SOCIAL SECURITY NUMBER
SPOUSE'S FIRST NAME AND INITIAL, IF FILING JOINTLY
SPOUSE'S LAST NAME, IF DIFFERENT
SPOUSE'S SOCIAL SECURITY NUMBER
CURRENT MAILING ADDRESS (NUMBER AND STREET, OR P. O. BOX)
APT. NO.
CITY, STATE AND ZIP CODE
SC1040
SC1040A
SC1040NR
KIND OF RETURN
DAY TIME TELEPHONE
SC1040X
SC1120
SC1041
(
)
TAX PERIOD ENDED
AMOUNT OF REFUND SHOWN ON RETURN: $________________
DATE RETURN WAS FILED: ____________________
CERTIFICATION
I DID NOT RECEIVE A TAX REFUND CHECK.
I RECEIVED A TAX REFUND CHECK, BUT IT WAS
LOST
STOLEN
DESTROYED.
I HAVE RECEIVED CORRESPONDENCE ABOUT THIS RETURN. (SEE INSTRUCTIONS BELOW.)
I HAVE NOT RECEIVED CORRESPONDENCE ABOUT THIS RETURN.
IF THE DEPARTMENT OF REVENUE CANNOT LOCATE THE CHECK, I REQUEST PAYMENT BE STOPPED AND A NEW
CHECK ISSUED.
IF THIS CHECK WAS A REFUND ON A JOINT RETURN, THE SIGNATURES OF BOTH HUSBAND AND WIFE ARE
NEEDED BEFORE THE CLAIM CAN BE PROCESSED.
YOUR SIGNATURE
DATE
INDIVIDUAL RETURN
SPOUSE'S SIGNATURE
DATE
SIGNATURE OF PERSON AUTHORIZED TO SIGN
TITLE
ALL OTHER RETURNS
(CORPORATION, TRUST,ETC.)
DATE
EMPLOYER IDENTIFICATION NO.
DESCRIPTION OF CHECK (FOR OFFICE USE ONLY)
DLN
DATE OF SEARCH
AMOUNT OF REFUND
REFUND CHECK NUMBER
DATE ON REFUND CHECK
REMARKS:
PLEASE ALLOW AT LEAST TWELVE WEEKS TO PROCESS A RETURN BEFORE FILING THIS FORM
If you have responded to the Department's request for additional information about your return, please allow 6 weeks from the date you
responded before filing this form.
If your return has been filed and you have failed to receive your refund within the time limit, a record search will be made upon request.
Complete this form, furnishing all required information. A reply will be made advising you of the results of the record search.
Social Security Privacy Act
It is mandatory that you provide your social security number on this tax form. 42 U.S.C 405(c)(2)(C)(i) permits a state to use an individual's
social security number as means of identification in administration of any tax. SC Regulation 117-1 mandates that any person required to
make a return to the SC Department of Revenue shall provide identifying numbers, as prescribed, for securing proper identification. Your
social security number is used for identification purposes.
Mail the completed form to:
SC DEPARTMENT OF REVENUE Income Tax Columbia, SC 29214-0015
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