ROSEBUD SIOUX TRIBE
MONTHLY OTHER TOBACCO PRODUCTS SALES
Mail to: Department of Revenue, Special Tax Division, 445 E Capitol Ave Pierre SD
Licensed tobacco distributors and wholesalers are herewith required to file reports of monthly
OTP sales into the Rosebud Sioux Reservation. All reports shall reflect the total monetary amount
(wholesale cost) sold in each period.
For the month of _____________________, 20__________
Rural Area, Todd County
Rosebud Casino/Travel Plaza
(address of Valentine NE)
St. Francis, SD
Hidden Timber, SD
I, the undersigned, certify that this return is an accurate and true report of all other tobacco
products sold into the Rosebud 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 above.