Standing Rock Sioux Tribe Monthly Other Tobacco Product Sales Form printable pdf download

Standing Rock Sioux Tribe Monthly Other Tobacco Product Sales Form

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

Retailers in:

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

Wakpala, SD

Walker, SD

Watauga, SD

Total Amount:

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.

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.

Standing Rock Sioux Tribe Monthly Other Tobacco Product Sales Form