Crow Creek Sioux Tribe Monthly Cigarette Sales Report

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CROW CREEK SIOUX TRIBE
MONTHLY CIGARETTE SALES REPORT
Mail to: Department of Revenue, Special Tax Division, 445 E Capitol Ave Pierre, SD 57501-3100
Cigarettes sold in the month of _______________________________, 20_____
Licensed tobacco distributors are required to file a monthly report of the number of cigarette packs sold within the
town or to the retail location listed below.
The report shall show the number of cigarette packs sold within the towns or to the following retailer:
Number of 20 cigarette packs
Number of 25 cigarette packs
Fort Thompson, SD
Lee's Corner
Stephan, SD
TOTAL NUMBER:
I, the undersigned, certify that this return is an accurate and true report of all packs of cigarettes sold
during the month indicated above.
Signed:________________________________________
Title:__________________________________________
Company:______________________________________
Address:_______________________________________
NOTE: This report is due prior to the 10th of each month listing all sales for the previous month and mailed to the address listed above.

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