Crow Creek Sioux Tribe Monthly Other Tobacco Product Sales Report Form printable pdf download

Crow Creek Sioux Tribe Monthly Other Tobacco Product Sales Report Form

CROW CREEK SIOUX TRIBE

MONTHLY OTHER TOBACCO PRODUCT SALES REPORT

Mail to: Department of Revenue, Special Tax Division, 445 E Capitol Ave Pierre, SD 57501-3100

Other tobacco products sold in the month of _______________________________, 20_____

Licensed tobacco distributors are required to file a monthly report of tobacco products (other than cigarettes)

sold within the towns or to the retail location listed below.

The report shall show the dollar amount of OTP sales within the following towns or to the retailer:

Fort Thompson, SD

Lee's Corner

Stephan, SD

TOTAL AMOUNT:

I, the undersigned, certify that this return is an accurate and true report of all other tobacco products 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.

Crow Creek Sioux Tribe Monthly Other Tobacco Product Sales Report Form