Form I-41 "Nonresident Beneficiary Affidavit and Agreement Income Tax Withholding" - South Carolina

What Is Form I-41?

This is a legal form that was released by the South Carolina Department of Revenue - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 30, 2019;
  • The latest edition provided by the South Carolina Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form I-41 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Revenue.

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Download Form I-41 "Nonresident Beneficiary Affidavit and Agreement Income Tax Withholding" - South Carolina

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STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
I-41
NONRESIDENT BENEFICIARY AFFIDAVIT AND
(Rev. 7/30/19)
dor.sc.gov
3346
AGREEMENT INCOME TAX WITHHOLDING
I certify and agree to the following:
1. I am a nonresident beneficiary.
2.
My name is:
My address is:
Street address
City, state, ZIP
3. My SSN or FEIN is:
4. The income this affidavit and agreement applies to is:
Distribution of South Carolina taxable income from a trust
Distribution of South Carolina taxable income from an estate
5.
Fiduciary's name:
6.
Fiduciary's address:
Street address
City, state, ZIP
7.
Fiduciary's FEIN:
I agree to timely file appropriate returns and make payment of all South Carolina taxes required by law.
8.
9.
I agree that I am subject to the personal jurisdiction of the SCDOR and the courts of South Carolina for the purpose of
determining and collecting any South Carolina taxes, including estimated taxes, together with any related interest and
penalties.
10. This agreement will be binding upon my heirs, representatives, assigns, successors, executors, and administrators.
I declare under penalty of perjury that I have examined this affidavit and that, to the best of my knowledge and belief, it is
true, correct, and complete.
Under SC Code Section 12-54-44(B)(6)(a), a person who willfully makes and subscribes any return, statement, or other
document that contains, or is verified by, a written declaration made under penalties of perjury that they do not believe to be
true and correct as to every material matter is guilty of a felony and, upon conviction, must be fined not more than $500 or
imprisoned not more than five years, or both, together with the cost of prosecution.
Signature of beneficiary
Date
Print name
33461021
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STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
I-41
NONRESIDENT BENEFICIARY AFFIDAVIT AND
(Rev. 7/30/19)
dor.sc.gov
3346
AGREEMENT INCOME TAX WITHHOLDING
I certify and agree to the following:
1. I am a nonresident beneficiary.
2.
My name is:
My address is:
Street address
City, state, ZIP
3. My SSN or FEIN is:
4. The income this affidavit and agreement applies to is:
Distribution of South Carolina taxable income from a trust
Distribution of South Carolina taxable income from an estate
5.
Fiduciary's name:
6.
Fiduciary's address:
Street address
City, state, ZIP
7.
Fiduciary's FEIN:
I agree to timely file appropriate returns and make payment of all South Carolina taxes required by law.
8.
9.
I agree that I am subject to the personal jurisdiction of the SCDOR and the courts of South Carolina for the purpose of
determining and collecting any South Carolina taxes, including estimated taxes, together with any related interest and
penalties.
10. This agreement will be binding upon my heirs, representatives, assigns, successors, executors, and administrators.
I declare under penalty of perjury that I have examined this affidavit and that, to the best of my knowledge and belief, it is
true, correct, and complete.
Under SC Code Section 12-54-44(B)(6)(a), a person who willfully makes and subscribes any return, statement, or other
document that contains, or is verified by, a written declaration made under penalties of perjury that they do not believe to be
true and correct as to every material matter is guilty of a felony and, upon conviction, must be fined not more than $500 or
imprisoned not more than five years, or both, together with the cost of prosecution.
Signature of beneficiary
Date
Print name
33461021
INSTRUCTIONS
Requirement to Make Withholding Payments
SC Code Section 12-8-570 requires a trust or an estate to withhold taxes at a rate of 7% on each nonresident
beneficiary's share of South Carolina taxable income.
Purpose of Affidavit
A trust or estate is not required to withhold taxes from any nonresident beneficiary who submits this completed affidavit
and agreement. Any Income Tax due must be paid by the original due date of the nonresident beneficiary's return and is
subject to the declaration of Estimated Tax rules.
Where and When to Submit This Affidavit
Beneficiary Instructions:
A nonresident beneficiary should fully complete the affidavit and submit it directly to the trust or estate. The affidavit is
valid for subsequent years and should not be resubmitted.
Trust or Estate Instructions:
The trust or estate must submit all affidavits to the SCDOR.
Attach all affidavits to the SC1041, Fiduciary Income Tax Return or the SC8736, Request for Extension of Time to File
South Carolina Tax Return for Fiduciary and Partnership on or before the 15th day of the fourth month following the close
of the trust or estate's tax year.
Affidavits remain valid for subsequent tax years and must only be filed with the SCDOR in the first year that the
nonresident beneficiary submits an affidavit to the trust or estate.
Find more information on filing requirements for Individual Income Tax at dor.sc.gov/iit and Fiduciary Income Tax at
dor.sc.gov/tax/fiduciary.
Social Security Privacy Act Disclosure
It is mandatory that you provide your Social Security Number on this tax form if you are an individual taxpayer. 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
117-201 mandates that any person required to make a return to the SCDOR must provide identifying numbers, as prescribed, for
securing proper identification. Your Social Security Number is used for identification purposes.
The Family Privacy Protection Act
Under the Family Privacy Protection Act, the collection of personal information from citizens by the SCDOR is limited to the information
necessary for the SCDOR to fulfill its statutory duties. In most instances, once this information is collected by the SCDOR, it is protected
by law from public disclosure. In those situations where public disclosure is not prohibited, the Family Privacy Protection Act prevents
such information from being used by third parties for commercial solicitation purposes.
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