SOUTH DAKOTA LOTTERY
LICENSE APPLICATION INSTRUCTIONS
Fill in all spaces as indicated.
1. Business Name: Enter the name of the business, as it appears to the general public.
Business Telephone: Enter the telephone number of the business.
2. SD Sales Tax #: Enter the South Dakota sales tax number for your business.
Federal Taxpayer ID #: Enter the Federal Taxpayer ID number for your business.
3. Address of Business: Enter the street address, county, city, state and zip code for your business.
Mailing Address: Enter the business mailing address if it is different from the business address.
5. Primary Business Bank: Enter the name and address of the bank where the principal business accounts
Bank Account Number(s): List the business bank account numbers.
6. Business Type: Check one box, indicating the type of business organization.
Depending upon the type of organization, the following people must each submit completed, notarized
"Individual History" and "Investigation Authorization" forms with the application.
Sole Proprietorship: All owners.
Partnership: Each general partner, limited partner or joint venture.
Corporation/Profit: Each officer and director (including parent company, if
subsidiary). Each stockholder who owns 5 percent or more stock.
Association, fraternal or civic: Each officer and director.
Trust: Each trustee.
7. Business Officials' Names: Using the information contained in item #6 above, list the names of all
individuals required to submit "Individual History" and "Investigation Authorization" forms. Attach them to
the License Application. If there are more than nine names, use an additional sheet and attach "Individual
History" and "Investigation Authorization" forms for each person named.
8. Contact Person: Enter the name of the business/organization's contact person regarding this application.
Title: Identify the contact person's position with the business/organization.
Telephone Numbers: List the contact person's business and residence telephone numbers.
9. Residence Address: Enter the complete home address of the contact person.
10. Question: If the business is currently delinquent in its financial obligations to the State of South Dakota,
give full details. This includes any current or pending litigation with the State.
11. Application Fee: Include a check or money order in the amount of $1,200, made payable to the SOUTH
DAKOTA LOTTERY. The $1,200 application fee and all forms are required for each location.
The application must be signed and dated by a person authorized by the business to file the application. The
original must be returned to the South Dakota Lottery office with the $1,200 fee and all other required "Individual
History" and "Investigation Authorization" forms. Make a copy for your records.