Rosebud Sioux Tribe Monthly Other Tobacco Products Sales Form printable pdf download

Rosebud Sioux Tribe Monthly Other Tobacco Products Sales Form

ROSEBUD 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 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__________

Retailers In:

Rural Area, Todd County

Parmelee, SD

Rosebud, SD

Rosebud Casino/Travel Plaza

(address of Valentine NE)

Mission, SD

Okreek, SD

St. Francis, SD

Olsonville, SD

Hidden Timber, SD

Total Amount:

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.

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.

Rosebud Sioux Tribe Monthly Other Tobacco Products Sales Form