Sd Eform-1902 V2 - South Dakota Alcoholic Beverage Carrier License Application
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2SD EForm -
Complete and use the button at the end to print for mailing.
HELP
1902
V2
Date Received_________________
License No.________________________
Date Issued___________________
South Dakota Alcoholic Beverage Carrier License Application
Mail to: South Dakota Department of Revenue, Special Tax Division, 445 East Capitol Ave, Pierre, SD 57501-3185
A. Owner Name and Address
B. Business Name and Mailing Address
Telephone #:
C. Vehicle License Numbers:
Carrier’s license: $100.00 per calendar year
(Mark one)
New License [ ]
Re-issuance [ ]
Have you ever been convicted of a felony? Yes [ ]
No [ ]
Certificate: The undersigned applicant certifies under the penalties of perjury, that all statements herein are true and
correct; that the said applicant complies with all of the statutory requirements for the class of license being applied for
and in additional agrees to permit agents of the Department of Revenue access to the licensed premises and records as
provided in SDCL 35-2-2.1 and agrees this application shall constitute a contract between applicant and the State of South
Dakota entitling the same or any peace officers to inspect the premises (conveyances), books and records of the applicant
for the purpose of enforcing the provisions of Title 35 SDCL, as amended.
Signed this ______ day of _________________, 20_____ Signature ________________________________________
For Department of Revenue use only
Amount of license fee collected: ______________
STATE LIQUOR AUTHORITY: APPROVAL ___________ REVIEW___________
Date deposited:___________________________ Deposited by:________________
Corporate/Partnership/LP/LLC applicants please complete other side
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