Manufacturer'S Malt Beverage Tax Report - South Dakota Department Of Revenue printable pdf download

Manufacturer'S Malt Beverage Tax Report - South Dakota Department Of Revenue

South Dakota Department of Revenue

Manufacturer’s Malt Beverage Tax Report

Name ____________________________________________________ License Number _________________________

Address __________________________________________________ Month of _______________________________

City & State _______________________________________________ Phone Number ___________________________

(Zip Code)

1. Monthly Sales (Barrels) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _________________________

2. Malt Beverage (from line 1) ___________Bbls. x $8.50 . . . . . . . . . . . . . . . . . . . . . . $_________________________

3. Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_________________________

4. Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_________________________

5. Total Tax, Penalty and Interest Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$_________________________

This report MUST be filed with full payment, on or before the 25

day of the second month following the reporting period.

I declare under the penalty of perjury that this report has been examined by me and to the best of my knowledge

and belief is a true, correct and complete report.

Signature of Licensee___________________________________________Date___________________________

Signature of preparer ___________________________________________

(if other than Licensee)

Mail To: Department of Revenue, P.O. Box 5055, Sioux Falls, South Dakota 57117

For Office Use Only

Malt Beverage No. 0086

$ _________________