SC Tax Form 2012

South Carolina Department of Revenue — 2012 SC1040 Individual Income Tax Return

STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE

2012 INDIVIDUAL INCOME TAX RETURN

Check this box if you are filing SC Schedule NR (Part year/Nonresident)

Check this box if you have filed a federal or state extension

Check this box if filing a composite return for partnership or "S" corporation

Check this box if this return is affected by a federally declared DISASTER AREA

Check this box if you served in a Military COMBAT ZONE during the filing period

Enter the name of the combat zone:

Enter the name of the disaster area:

Check your federal filing status:

Enter spouse's SSN here (if married filing separately):

Enter the number of exemptions listed above that were under the age of 6 years on December 31, 2012:

Enter the number of taxpayers age 65 or older, as of December 31, 2012:

Enter the number of exemptions from your 2012 federal return:

Dependents:

Income and Adjustments

1. Enter federal taxable income from your federal form:

a. State tax addback, if itemizing on federal return:

b. Out-of-state losses:

c. Expenses related to National Guard and Military Reserve income:

d. Interest income on obligations of states and political subdivisions other than South Carolina:

e. Other additions to income:

Subtractions from Federal Taxable Income

f. State tax refund:

g. Total and permanent disability retirement income:

h. Out-of-state rental/business or real estate income not taxable to South Carolina:

i. Net capital gain deduction:

j. Volunteer deduction:

k. Contributions to the SC College Investment Program or SC Tuition Prepayment Program:

l. Active trade or business income deduction:

m. Interest from U.S. obligations:

n. Certain nontaxable National Guard or Reserve pay:

o. Social Security and/or railroad retirement amount if taxed by federal:

p. Retirement deduction:

Taxpayer date of birth:

Spouse date of birth:

q. Age 65 and older deduction:

r. Negative amount of federal taxable income:

s. Subsistence allowance days @ $8.00:

t. Dependents under the age of 6 years on December 31 of the tax year:

u. Other subtractions:

Tax, Payments, Refunds, and Balance Due

6. Tax from South Carolina tax tables:

7. Tax on lump sum distribution:

8. Tax on active trade or business income:

9. Tax on excess withdrawals from catastrophe savings accounts:

11. Child and dependent care credit:

12. Two wage earner credit:

13. Other non-refundable credits:

16. SC income tax withheld from wages:

17. 2012 estimated tax payments:

18. Amount paid with extension:

19. NR sale of real estate:

20. Other SC withholding:

21. Tuition tax credit:

22. Other refundable credit(s):

26. Use tax:

27. Amount of line 24 to be credited to 2013 estimated tax:

28. Total contributions for check-offs:

29. Add lines 26 through 28:

30. Refund amount:

30a. Refund option:

30b. Direct deposit account type:

Routing number (RTN):

Bank account number (BAN):

31. Net tax:

32. Late filing and/or late payment penalties and interest:

33. Underpayment of estimated tax:

Exception to underpayment of estimated tax:

34. Balance due / amount you owe:

Signature Section

Authorization to discuss return with preparer: Yes No

SC1040-V Payment Voucher

Name control (first 4 letters of last name):

Taxpayer name and address:

Payment amount:

Composite filer:

Spouse's SSN (if joint):