Sd Eform 0894 - Standing Rock Sioux Tribe Monthly Cigarette Sales Page 2
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5SANTEE SIOUX TRIEE
MONTHLY CIGARETTE SALES
Mail to: Department Of Revenue, Special Tax Division, 445 E. Capitol Avenue, Pierre, SD 57501-3100
Licensed cigarette distributors are herewith required to file reports of monthly cigarette sales to the Santee Sioux Tribal
Store. All reports shall reflect the total number of cartons sold in each period.
Cartons of cigarettes sold in the month of _______________________________________________ , 20__________
Number of Cartons
Tribal Store in the Town
20
25
25
of:
8 pks/crt
10 pks/crt
Flandreau
Total Number
I, the undersigned certify that this return is an accurate and true report of all cartons of cigarettes sold during the month
indicated above to the Santee Sioux Tribal Store.
Signed: ___________________________
Title: _____________________________
Firm: _____________________________
Address: __________________________
NOTE: This report is due prior to the 10th of each month, listing all sales for the previous month and mailed to the address listed
above.
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