Form 2145 - South Dakota Yankton Sioux Tribe Monthly Other Tobacco Product Sales Report

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SD EForm - 2145
V1
HELP
Complete and use the button at the end to print for mailing.
YANKTON SIOUX TRIBE
MONTHLY OTHER TOBACCO PRODUCT SALES REPORT
Mail to: Department of Revenue, Special Tax Division, 445 E Capitol Ave Pierre, SD 57501-3100
Other tobacco products sold in the month of _______________________________, 20_____
Licensed tobacco distributors are required to file a monthly report of tobacco products (other than cigarettes)
sold to retail locations listed below.
The report shall show the dollar amount of OTP sales to the following retailers:
Fort Randall Casino, Pickstown
$
Yankton Sioux Travel Plaza,
$
Pickstown
TOTAL AMOUNT:
$
0.00
I, the undersigned, certify that this return is an accurate and true report of all other tobacco products sold
during the month indicated above.
Signed: ________________________________________
Title: __________________________________________
Company: ______________________________________
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.
1.
PRINT FOR MAILING
CLEAR FORM

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