Sd Eform-0891 V6 - South Dakota Cigarette Stamp Order Blank & Receipt Form
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1SD EForm -
0891
V6
Complete and use the button at the end to print for mailing.
HELP
South Dakota Cigarette Stamp Order Blank & Receipt Form
SPT-306
South Dakota Department of Revenue
Revised 07/12
445 E. Capitol Avenue | Pierre, SD 57501-3185 | 1-800-TAX-9188
Part I Information
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Part II Order Form
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Part I Information
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Make Remittance payable to the SD State Treasurer or the
0.00
Total Value of Stamps
$ ________________
SD Department of Revenue.
0.00
Less 1% Discount
$ ________________
0.00
Subtotal
$ ________________
Less Credit Memo #
$ ________________
Distributor will be billed for the cost of heat applied to
stamp paper.
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Total Amount of Remittance
$ ________________
Signature of Distributor or Authorized Agent _________________________________________________________________
Part III Receipt
For Department of Revenue Use Only
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Total Amount of Remittance received
$ _______________________
Signature of Authorized Issuing Agent ____________________________ Date ____________________________________
Signature of person receiving stamps (if physical delivery) ______________________________________________________
Part IV Receipt
Distributor completes Part I & II.
SEND TO: SD Department of Revenue
Special Tax Division
445 East Capitol Avenue
Pierre, SD 57501-3185
PRINT FOR MAILING
CLEAR FORM
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