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Reset Form STATE OF SOUTH CAROLINA Print Form CID-27 DEPARTMENT OF REVENUE Rev. 6/23/11 TAX VIOLATION COMPLAINT 1. Taxpayer Name 2. Business Name a* Street Address b. City/State/Zip c* Social Security Number SSN c* Employer Identification Number FEIN d. Occupation d. Principal Business Activity e. Date of Birth 3. Marital Status Married Separated 4. Type of Fraud Mark all that Apply Single Head of Household Divorced Individual Income Withholding Corporate Income Other Sales Use Tax 5. Brief description of the fraud being reported Please forward copies of any supporting documents. 6. Please describe how you learned and/or obtained the information in this report. Attach another sheet if needed* 90311010. Taxpayer Name 2. Business Name a* Street Address b. City/State/Zip c* Social Security Number SSN c* Employer Identification Number FEIN d. Occupation d. Principal Business Activity e. Date of Birth 3. Marital Status Married Separated 4. Type of Fraud Mark all that Apply Single Head of Household Divorced Individual Income Withholding Corporate Income Other Sales Use Tax 5. Occupation d. Principal Business Activity e. Date of Birth 3. Marital Status Married Separated 4. Type of Fraud Mark all that Apply Single Head of Household Divorced Individual Income Withholding Corporate Income Other Sales Use Tax 5. Brief description of the fraud being reported Please forward copies of any supporting documents. 6. Brief description of the fraud being reported Please forward copies of any supporting documents. 6. Please describe how you learned and/or obtained the information in this report. Attach another sheet if needed* 90311010. Taxpayer Name 2. Business Name a* Street Address b. City/State/Zip c* Social Security Number SSN c* Employer Identification Number FEIN d. Occupation d. Principal Business Activity e. Date of Birth 3. Marital Status Married Separated 4. Type of Fraud Mark all that Apply Single Head of Household Divorced Individual Income Withholding Corporate Income Other Sales Use Tax 5. Brief description of the fraud being reported Please forward copies of any supporting documents. 6. Occupation d. Principal Business Activity e. Date of Birth 3. Marital Status Married Separated 4. Type of Fraud Mark all that Apply Single Head of Household Divorced Individual Income Withholding Corporate Income Other Sales Use Tax 5. Brief description of the fraud being reported Please forward copies of any supporting documents. 6. Please describe how you learned and/or obtained the information in this report. Attach another sheet if needed* 90311010.