Prime Contractors' Excise Tax Certificate Form

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STATE OF SOUTH DAKOTA
SALES TAX DIVISION
PRIME CONTRACTORS’ EXCISE TAX CERTIFICATE
***** Retention of the certificate relieves the subcontractor from liability for contractors’ excise tax for the project designated. *****
PRIME CONTRACTOR:
SUBCONTRACTOR:
License Number ___________________________________________
Name________________________________________
Name____________________________________________________
Address______________________________________
Address__________________________________________________
City/State____________________________________
City/State_________________________________________________
Zip__________________________________________
Zip______________________________________________________
PROJECT DESCRIPTION:
________________________________________________________________________________________________________________
A certificate cannot be issued by an owner of a project, the United States, the State of South Dakota,
or any other state, public or municipal corporation. Improper issuance of this certificate by a person not a
prime contractor will result in the imposition of a penalty of 10% of the tax due upon the person issuing
the certifiate.
_____________________________________________________________
Authorized Signature of the Prime Contractor

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