STANDING ROCK SIOUX TRIBE
MONTHLY OTHER TOBACCO PRODUCTS SALES
Mail to: Department of Revenue, Special Tax Division, 445 E Capitol Ave Pierre SD 57501-3100
Licensed tobacco distributors are herewith required to file reports of monthly other tobacco products sales into the
Standing Rock Sioux Reservation. All reports shall reflect the total wholesale cost of product sold in each period.
Other Tobacco Products sold in the month of _______________________________________________, 20__________
Wholesale Dollar Amount of OTP
Corson County, SD
Little Eagle, SD
Thunder Hawk, SD
Trail City, SD
I, the undersigned, certify that this return is an accurate and true report of the wholesale dollar amount of other tobacco
products sold into the Standing Rock Sioux Reservation during the month indicated above.
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