Form 1783 - South Dakota Tobacco Product Manufacturer Complementary Legislation Certification Page 7

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C.
The Financial Institution identified in Part 5(A) must provide the following directly to the SD Department of
Revenue Office:
I.
Proof of amount and date of deposit for year 2011 sales into the Non-participating Manufacturer’s
segregated South Dakota sub-account in the Escrow Account.
II.
Current account ledger for the Non-participating Manufacturer’s segregated South Dakota sub-account in
the Escrow Account.
NOTE: These items are part of the Certification and are due by April 30.
PART 8: NONPARTICIPATING MANUFACTURER’S CONSENT TO SUIT
The undersigned _____________________ (name of Non-participating Manufacturer), for the purpose of
complying with the laws of the State of South Dakota relating to tobacco manufacturer certification (SDCL ch. 10-
50-72 et. seq.) and to the escrow funds for tobacco litigation (SDCL ch. 10-50B), does hereby consent that any
action or proceeding against it arising from enforcement of the provisions of SDCL chs. 10-50 or 10-50B, and any
rules promulgated pursuant to these statutes, may be commenced in any state court of competent jurisdiction
within South Dakota.
Date: ___________________
_______________________________________________
Signature of authorized representative of
Non-participating Manufacturer
The following must be attached:
I.
Proof of authority to consent to suit on behalf of the Non-participating Manufacturer, such as a
resolution by the Non-participating Manufacturer specifically agreeing to the consent to suit
provision and any required approval by an applicable governmental agency.
II.
Proof of authority given to the signing party to execute the consent to suit provision.
Mail this completed Complementary Legislation Certification and attachments to:
South Dakota Department of Revenue
Mickelson Building
1302 E. Highway 14 Suite 1
Pierre, SD 57501
7

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