Sd Eform 1367 - Distributor/wholesaler Tobacco Products Monthly Tax Return

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SD EForm - 1367

South Dakota

Distributor/Wholesaler

Tobacco Products Monthly Tax Return

This return is due on or before the l5th day of the month following the month during which the tobacco products were

imported or shipped into South Dakota.

Individual or Corporate Name, Mailing Address,

Month of:

Year:

City, State, & Zip:

FEIN/SS No.:

Tobacco Distributor/Wholesaler

License No.:

Contact:

Phone No.:

A. Wholesale purchase price of tobacco products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

B. Deductions (from line iii on side 2)

$ __________________

0.00

) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Taxable value of tobacco products (line A minus line B) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$__________________

0.00

D. Tax @ 10% (amount of line C times .10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

0.00

E. Interest for late payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

F. Penalty for late filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

PLEASE PAY THIS AMOUNT (the total of Lines D + E + F) . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

0.00

Invoice Date

Invoice

South Dakota Recipient

Mfg. Gross List Price of

Number

Tobacco Products

Total (Page 2)

0.00

(cont. on side 2)

0.00