Sd Eform 1752 - South Dakota Alcoholic Beverage Solicitor License Application
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1SD EForm - 1752
V1
Complete and use the button at the end to print for mailing.
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Date Received_________________
License No.________________________
Date Issued___________________
South Dakota Alcoholic Beverage Solicitor License Application
Mail to: South Dakota Department of Revenue, Special Tax Division, 445 East Capitol Ave, Pierre, SD 57501-3100
A. Individual’s Name and Address
B. Company Name and Address
Company Telephone #:
Solicitor’s license: $25.00
(Mark one)
New License?____________
Re-issuance?____________
Certificate: The undersigned applicant certifies under the penalties of perjury, that all statements herein are true and
correct; that the said applicant complies with all of the statutory requirements for the class of license being applied for
and in additional agrees to permit agents of the Department of Revenue access to records and agrees this application
shall constitute a contract between applicant and the State of South Dakota entitling the same or any peace officers to
inspect books and records of the applicant for the purpose of enforcing the provisions of Title 35 SDCL, as amended.
Signed this ______ day of _________________, 20_____ Signature ________________________________________
For Department of Revenue use only
Amount of license fee collected: ______________
STATE LIQUOR AUTHORITY: APPROVAL ___________ REVIEW___________
Date deposited:___________________________ Deposited by:________________
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