Form Spt 801 - South Dakota Application To Register Special Amusement Machines

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South Dakota Application to Register Special Amusement Machines
(Antique Machines or Machines used only at Fairs)
for the period ending _____________, 20___
Owner Name _____________________________________ Business Name ___________________________________
Business Address __________________________________ Mailing Address __________________________________
City ____________________________________________ State ________________
Zip ______________________
Type of ownership:
Sole Prop.
Partnership
Corporation
Identify partners or corporate officers:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
NOTE: This form applies ONLY to Antique Amusement Machines (machines manufactured before 1940) or
machines used exclusively at Government Sponsored FAIRS (see instructions).
ANTIQUE MACHINES
Number of Machines registered (NO FEE is due for antique machines)
_________________________
DEVICES USED SOLELY AT FAIRS
1. List municipalities where machines are located and the number of machines in each municipality. (attach additional
sheets if needed)
A. City
B. Number of Machines X $3.00=
C. Fee
________________________
_____________________________
____________________________
________________________
_____________________________
____________________________
________________________
_____________________________
____________________________
2. Total from machines located within a municipality
$_________________________
3. Number of machines NOT located within a municipality ______________ x $3.00
$_________________________
4. TOTAL DUE (add lines 2 and 3 and remit this amount)
$_________________________
5. Specify period machines will be in service (30 consecutive days)
Beginning Date _________________
Ending Date ______________________
I swear, under penalty of perjury, that this information is true, correct and complete.
Signature ______________________________________________________________ Date _____________________
SPT 801
Please Read Reverse Side of This Form

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