Sd Eform-0894 V5 - Standing Rock Sioux Tribe Monthly Cigarette Sales

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SD EForm - 0894
V5
STANDING ROCK SIOUX TRIBE
MONTHLY CIGARETTE SALES
Mail to: Department of Revenue, Special Tax Division, 445 E Capitol Ave Pierre SD 57501-3100
Licensed cigarette distributors are herewith required to file reports of monthly cigarette sales into the Standing Rock
Sioux Reservation. All reports shall reflect the total number of cartons sold in each period.
Cartons of cigarettes sold in the month of _______________________________________________, 20__________
Number of Cartons
Retailers in:
25
25
20
8pks/crt.
10 pks/crt
Corson County, SD:
Bullhead, SD
Keldron, SD
Kenel, SD
Little Eagle, SD
Mahto, SD
McLaughlin, SD
McIntosh, SD
Morristown, SD
Thunder Hawk, SD
Trail City, SD
Walker, SD
Watauga, SD
Total Number
0
0
0
I, the undersigned, certify that this return is an accurate and true report of all cartons of cigarettes sold into the Standing
Rock Sioux Reservation during the month indicated above.
Signed: ______________________________
Title: ________________________________
Firm: ________________________________
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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