Sd Eform 0893 - In-State Cigarette Distributors' Monthly Report - South Dakota Department Of Revenue 2003

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SD EForm - 0893
V1
HELP
Complete and use the button at the end to print for mailing.
In-State Cigarette Distributors’ Monthly Report
Mail to: Department of Revenue & Regulation, Special Tax Division, 445 East Capitol Ave, Pierre, SD 57501-3100
Name ______________________________________________ License No.________________________________________
Address____________________________________________ County ___________________________________________
City or Town_________________________________________ State_____________________________________________
Month Ending__________________________, 20__________ Phone No._________________________________________
This report must be filed with the Department of Revenue & Regulation, Pierre, South Dakota by the 15th day of the month following the period for which the report is filed.
Record of purchases, Sales and Inventory of Cigarettes
Total Packages of
20 Cigarettes
1.
On hand first of month-unstamped (Packages of 20 cigarettes)
1. _____________________
2.
Received during month (Packages of 20 cigarettes)
2. _____________________
0
3.
TOTAL (add lines 1 & 2) (Packages of 20 cigarettes)
3. _____________________
4.
Sales outside of South Dakota (Packages of 20 cigarettes) (Schedule A)
4. _____________________
5.
Sales to licensed dealers inside South Dakota (Schedule B)
5. _____________________
6.
Unstamped merchandise on hand last of month
6. _____________________
0
7.
TOTAL DEDUCTIONS (Add lines 4, 5 and 6)
7. _____________________
0
8.
Subject to South Dakota tax (line 3 minus line 7)
8. _____________________
9.
Rate of tax
9.
$ 0.53 per pkg of 20 cigs.
0.00
10. TAX
10. _____________________
Record of Purchases, Sales and Inventory of Cigarettes
Total Packages of
25 Cigarettes
1A. On hand first of month-unstamped (Packages of 25 cigarettes)
1A. _____________________
2A. Received during month (Packages of 25 cigarettes)
2A. _____________________
0
3A. TOTAL (add lines IA and 2A) (Packages of 25 cigarettes)
3A. _____________________
4A. Sales outside of South Dakota (Packages of 25 cigarettes) (Schedule A)
4A. _____________________
5A. Sales to unlicensed dealers inside South Dakota (Schedule B)
5A. _____________________
6A. Unstamped merchandise on hand last of month
6A. _____________________
0
7A. TOTAL DEDUCTIONS (Add lines 4A, 5A and 6A)
7A. _____________________
0
8A. Subject to South Dakota tax (line 3A minus line 7A)
8A. _____________________
9A. Rate of tax
9A. $ 0.67 per pkg of 25 cigs.
$0.00
10A. TAX
10A._____________________
Record of Stamps Purchased and Used
Stamps
Stamps
Value
$0.67
$0.53
1. Number of unused stamps on hand first of month
0.00
$
2. Number purchased during month
0.00
$
3. TOTAL (add lines 1 and 2)
0
0
0.00
$
4. Number of unused stamps on hand last of month (deduct)
0.00
$
5. Number of stamps used during month
0
0.00
0
$
6. Value of stamps used during month
$
0.00
$
0.00
0.00
$
I hereby certify that to the best of my knowledge and belief the within and foregoing report is true and correct, and that no cigarettes
have been sold or disposed of nor stamped contrary to the provisions of SDCL 1967 10-50.
Dated this________day of _____________ , 20______
_______________________________________________________
Signature of Manager or Official of Company
SD REV SPT 303 (3-03)
PRINT FOR MAILING
EXIT
CLEAR FORM
1.
2.

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