Sd Eform - 1901 V1 - South Dakota Alcoholic Beverage Transporter License Application
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SD EForm - 1901
HELP
V1
Date Received_________________
License No.________________________
Date Issued___________________
South Dakota Alcoholic Beverage Transporter 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
Sales tax number (if applicable):
Telephone #:
Transporter’s license fee: $25.00 per calendar year
(Mark one)
New License____________
Re-issuance____________
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 records 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 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:________________
Corporation applicants please complete other side
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