New Retail Tobacco Store Affidavit - State Of South Dakota printable pdf download

New Retail Tobacco Store Affidavit - State Of South Dakota

STATE OF SOUTH DAKOTA

)

NEW RETAIL TOBACCO

:SS

COUNTY OF ________________ )

STORE AFFIDAVIT

I, ________________________, am an owner of _________________________,

that has South Dakota sales tax license number _______________, which is a business

that I intend to establish as a retail tobacco store as described in SDCL 34-46-19.

I certify that the retail tobacco store is a new establishment and that it will

generate sixty-five percent or more of the annual gross income from the sale of tobacco,

tobacco products, and accessories for such products.

I swear under oath and under penalty of perjury that the above statements are true.

I further swear that I will provide the South Dakota Department of Revenue & Regulation

additional information on the retail tobacco store’s gross income once the first sales tax

return is filed.

Dated the ___________day of ______________, 20__.

______________________________

Signature

Subscribed and sworn to before me this _______day of _______________, 20__.

______________________________

NOTARY PUBLIC-SOUTH DAKOTA

(SEAL)

My Commission Expires:

New Retail Tobacco Store Affidavit - State Of South Dakota