Form 2008 - South Carolina Sisseton-Wahpeton Oyate Monthly Other Tobacco Product Sales Report

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SD EForm - 2008
V1
Complete and use the button at the end to print for mailing.
SISSETON-WAHPETON OYATE
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:
Dakota Connection Casino/Convenience Store/Filling Station
$
Agency Village Convenience Store/Filling Station
$
Dakota Sioux Hotel/Casino/Convenience Store/Filling Station
$
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.
PRINT FOR MAILING
CLEAR FORM

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