Sd Eform-0879 V1 - Application For Trading Stamp Redemption License

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SD EForm - 0879
V1
STATE OF SOUTH DAKOTA
APPLICATION FOR TRADING STAMP REDEMPTION LICENSE
1.
Name of applicant:
2.
Mailing address:
3.
Business name:
4.
Type of ownership:
5.
Principal place of business:
6.
Places of business in South Dakota (attach exhibit if necessary):
7.
Application for the year:
8.
Total gross business transacted in previous year:
9.
Gross business transacted in South Dakota in previous year:
10.
Financial statement (attach exhibit reflecting capital stock liabilities and assets or
any other document reflecting financial status).
11.
Total assets in South Dakota:
12.
Uniform Surety bonds in the sum of $10,000.00 in force –
Insurance Policy Number:
____________________________________
Signature
____________________________________
Title
Mail to:
Special Tax Division, Department of Revenue, 445 E Capital Ave, Pierre, SD 57501-3100
Fee:
$50.00 – to be included with this application. (Calendar year)
1.
PRINT FOR MAILING
CLEAR FORM

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