SD EForm - 2121
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Annual Tobacco Sales Reporting Form
South Dakota Department of Revenue
445 E. Capitol Ave, Pierre, SD 57501-3185 1-800-TAX-9188
Sales Tax License Number:
Owner Name:
Business Name:
Address:
Phone Number:
Email Address:
Cigar Bar
Any establishment meeting the requirements of SDCL 34-46-18 may permit the smoking of cigars and any
premium tobacco product purchased on the premises.
Establishments meeting the requirements of this statute are to report annually to the Department of
Revenue the revenue generated from the sale of cigars as a percentage of annual gross income. The
establishment must generate ten percent or more of its annual gross income from the sale
of cigars. A cigar is any individual roll of tobacco that has a wrapper or cover consisting only of tobacco,
that measures a number forty ring size or larger, and that is sold without a filter.
If your establishment meets the requirements of a cigar bar please complete the section below.
Annual gross
YEAR
income
Cigar income
Percent of total
0.00 %
Retail Tobacco Store
Any retail tobacco store meeting the requirements of SDCL 34-46-19 may permit smoking on the
premises.
Any retail tobacco store meeting the requirements of this statute are to report annually to the Department
of Revenue the revenue generated from the sale of tobacco, tobacco products, and
accessories for such products as a percentage of annual gross income. The store must generate sixty-five
percent of its annual gross income from the sale of tobacco, tobacco products, and accessories for such
products.
If your establishment meets the requirements of a retail tobacco store please complete the section below.
Annual gross
YEAR
income
Tobacco income
Percent of total
0.00 %
I declare that the information on this form is correct and complete to the best of my knowledge
and belief.
_____________________________________________________________________________
Name:
Title:
Date:
or
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