Form Rv121 - Statewide Sales Tax Permit Application printable pdf download

Statewide Sales Tax Permit Application

NOTE: Statewide sales tax permits may only be issued to businesses with identical ownership, the same federal

identification number, the same Standard Industrial Classification number, and the same license type. Any business

requesting a statewide sales tax permit must maintain records that clearly show gross receipts, deductions, and municipal

sales for each location reported under the statewide permit. Such records shall be stored and available in one location.

Owner/Corporate Name _______________________________________________________________________

Contact Person ______________________________________________________________________________

Mailing Address ______________________________________________________________________________

Telephone Number _______________________________ Fax Number ________________________________

FEIN/Social Security Number ___________________________________________________________________

E-mail Address ______________________________________________________________________________

Location of Records ___________________________________________________________________________

South Dakota Tax License Numbers that would be reported under the consolidated number (attach additional

sheets if necessary).

1._______________________________________

9._______________________________________

2._______________________________________

10._______________________________________

3._______________________________________

11. _______________________________________

4._______________________________________

12. _______________________________________

5._______________________________________

13. _______________________________________

6._______________________________________

14. _______________________________________

7._______________________________________

15. _______________________________________

8._______________________________________

16. _______________________________________

Signature of owner/corporate officer

Date

For Department use:

Comments: _________________________________________________________________________________

___________________________________________________________________________________________

Consolidated Number ________________________________________________________________________

South Dakota Department of Revenue

445 East Capitol Avenue

Pierre, SD 57501

1-800-TAX-9188

RV121 10/00

Form Rv121 - Statewide Sales Tax Permit Application