Form C-268 - Certificate Of Tax Compliance Request Form
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1
2STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
C-268
(Rev. 11/7/12)
CERTIFICATE OF TAX COMPLIANCE REQUEST FORM
6207
SECTION 1 - REQUESTOR INFORMATION
FOR OFFICE USE ONLY
This request is being made by:
Taxpayer
Other* (explain)
* A power of attorney must be attached to this request.
Period
Title
Company
File Number
94-8010
Requestor Name
Address
City
State
Zip Code
Telephone Number
(
)
Fax Number
(
)
Please provide the name of the person(s) authorized to discuss confidential tax information pertaining to this request if additional
information is needed.
Name
Relationship to Taxpayer
Telephone Number
Fax Number
Check here if certificate is being requested for corporate reinstatement after administrative dissolution.
SECTION 2 - TAXPAYER INFORMATION
Legal Name
Name as Filed on Return/Business Name
Mailing Address:
(
)
City:
State:
Zip:
Telephone Number:
Principal Activity of Taxpayer:
SSN/FEI Number:
Corporate File Number:
Withholding Acct Number:
Retail License Number:
Other Applicable Identification Number(s):
State of Incorporation:
How was business acquired?
Purchase
Started (Start Date)
Merger (Date of Merger)
Is this entity a single member LLC?
yes
no
If yes, is it a disregarded entity?
yes
no
Owners' Name
FEI Number/SS#:
As a single member LLC, we must have your SSN# or FEI# to complete this process. If not, it may cause a delay in processing.
SECTION 3 - PERSON TO RECEIVE RESPONSE
Check applicable blocks:
Send results to the taxpayer.
Send results to the person below only if taxpayer is in compliance and Power of Attorney is attached.
Send results to the person named below, even if the taxpayer is not in compliance.
If information is to be mailed to someone other than the taxpayer, provide the party's name and mailing address:
Name
Address
City/State/Zip
(
)
(
)
Telephone Number:
Fax Number:
SECTION 4 - PAYMENT OF $60.00 SHOULD BE ATTACHED TO THIS FORM.
Amount enclosed ..........................................................................................................................................
Signature of Requestor
Title (if applicable)
Print Name
Date
62071014
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