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2. Return By:
   Date will be provided when mailed.
4. 1. Owner of Property on January 1st:*
6. 2. Has there been a transfer of ownership or transfer of interest in ownership between January 1st and December 31st of the current year?*

   1. Yes

   1. No
8. 3. If yes, please provide the name and address of the new owner, if the owner above is not correct:
10. Nature of ownership interest transferred:
12. 4. If partial interest transfer, list other partial interest owners, percent interest for each, and relationship of grantor to grantee:
14. Your Contact Information
16. 5. Daytime Telephone:*
17. 6. Email Address:*
19. 7. Mailing Address*
21. 8. Your Role*

    1. Owner

    1. Owner's Agent

    1. Other
22. If 'Other', Indicate your Title:
24. Property Tax Map Number:*
26. Penalty
    If owner or owner’s agent knowingly falsifies the details on the Certificate, the owner or owner’s agent is subject to a civil penalty. Penalty must not be less than two times the taxes lawfully due or more than three times the taxes lawfully due.
28. Failure to return this Certificate may result in your property being revalued for property tax purposes. Return this entire document. Retain a copy for your records if you desire.
    This form must not be faxed, nor can electronic transmissions be accepted. When complete, print and sign this form (electronic signatures not accepted), and submit by mail. This Certificate is required by S.C. Code Ann. Section 12-37-3160(B).
30. Signature
31. Date
    Date
Leave This Blank:


32. Print Only

* indicates a required field