Sd Eform 1338 - Application For License To Distribute Bingo And Lottery Equipment And Supplies - South Dakota Department Of Revenue Page 2

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Application For License To Distribute Bingo And Lottery Equipment And Supplies
9. Are all persons listed in No. 6 or No. 7 of good moral character and have never been convicted of a crime of
moral turpitude?
Yes
No
10. Is the applicant a wholesale distributor of alcoholic beverages?
Yes
No
The signatories to this application consent, on behalf of this distributor, to permit the Secretary of Revenue or
his agents to enter upon and inspect any site where bingo or lottery equipment or supplies are stored by this
distributor and authorize inspection at any location of any records of the distributor connected with the sale of
bingo or lottery equipment in South Dakota without warrant or court process.
Under penalty of perjury, I declare that the information submitted herewith is compete and accurate to the best
of my knowledge.
Signature (ceo/owner)
Date
Name (please print)
Title
Signature of partners
Signature of partner
Signature of partner
Signature of partner
Signature of preparer
Name/position of preparer
Instructions
A. All questions must be answered or marked N/A, if not applicable. Incomplete application may be
returned.
B. License fee: $5,000.00 (make check payable to SD Treasurer) License Year: January 1 through
December 31.
C. Only one license application and fee is necessary for each entity regardless of number of warehouse
locations.
D. A tax of 5% is imposed on the gross sales of bingo and lottery equipment and supplies (including pull-
tabs) Returns are filed and taxes paid on or before the 15th day of the month following the month in
which the sale occurred.
E. Attach additional sheets if necessary.
F. Changes in report information must be reported within 10 days.
G. Mail application to: Special Tax Division, 445 E capitol Avenue, Pierre, SD 57501-3100.

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