Sd Eform 1369 - Retailer Tobacco Products Monthly Tax Return

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SD EForm - 1369

South Dakota

Retailer

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.

This return is due only for those tobacco products you have purchased from a supplier who is NOT licensed as a South

Dakota Distributor or Wholesaler.

Individual or Corporate Name, Mailing Address,

Month of:

Year:

City, State, & Zip:

FEIN/SS No.:

Tobacco Distributor/Wholesaler

License No.:

Contact:

Phone No.:

Purchase price of tobacco products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

0.00

B. Deductions for returns to supplier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

C. Deduction for products mailed or shipped out-of-state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

0.00

D. Taxable value of tobacco products (line A minus lines B + C) . . . . . . . . . . . . . . . . . . . . . . . . $___________________

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

0.00

F. Interest for late payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

G. Penalty for late filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

H. PLEASE PAY THIS AMOUNT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________

0.00

Invoice Date

Invoice

Purchased

Purchase Price from

Number

From

your supplier

(cont. on side 2)

Total From Side 2

0.00