Sd Eform 1751 - Price Filing Amendment Form
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1SD EForm - 1751
V1
Complete and use the button at the end to print for mailing.
HELP
PRICE FILING AMENDMENT FORM
We hereby submit price list for new
Filed___________________________
brand not heretofore sold:
Effective________________________
BRAND NAME
PROOF
CONTAINERS
CASE PRICE
BOTTLE PRICE
We hereby submit amendment to the
Filed_______________________________
present prevailing Price List which
was filed on __________________.
Effective___________________________
(List in identical form the description and prices formerly filed, followed by the new price. Explain on this
form the reason for price change, or attach letter of explanation.)
OLD
NEW
NEW
SIZE
CASE PRICE
CASE PRICE
BOTTLE PRICE
Dated______________________________
Wholesaler_______________________________
Signed by:________________________________
Amended or New price filing, Filed______day of _________________________________ 20_______
Amended price filing disapproved this ________day of _____________________________ 20_______
Department of Revenue
Special Taxes Division
By_____________________________________________
SD REV SPT 116 - 500
PRINT FOR MAILING
EXIT
CLEAR FORM
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