STATE OF SOUTH CAROLINA
1350
1350
DEPARTMENT OF REVENUE
ST-299
AFFIDAVIT FOR DELIVERY OF TANGIBLE PERSONAL
(Rev. 7/15/10)
PROPERTY TO THE PURCHASER IN A STATE OTHER
5039
THAN SOUTH CAROLINA
AFFIDAVIT
STATE OF
COUNTY OF
Personally appeared the below named purchaser, who being duly sworn, deposes and says that the property listed below
is purchased for use, storage or other consumption outside of South Carolina, that the property will not be returned for
use, storage or other consumption in South Carolina, and that the purchaser has read and understands the law as printed
on the reverse side of this form.
Name of Purchaser
City and State of Delivery
State of Residence and
Address of Purchaser
(Street)
(City)
(State)
(Zip)
Name of Seller
Address of Seller
(Street)
(City)
(State)
(Zip)
Seller's Retail License Number
Date of Sale
(Month)
(Date)
(year)
DESCRIPTION OF PROPERTY:
Item:
Model:
Serial Number:
Purchase Price $
Trade-In Allowance $
Net Amt. Paid $
Further deponent sayeth not.
(Signature of Purchaser)
Sworn to and subscribed before me
this
day of
, year of
.
(Notary Public for
)
VALID ONLY WITH PROOF OF DELIVERY OUTSIDE STATE OF SOUTH CAROLINA
SEE REVERSE SIDE
ORIGINAL
Copy
Provided for purchaser.
Retained by seller.
50391010