Form 2148 - South Dakota Sisseton-Wahpeton Oyate Monthly Cigarette Sales Report

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SD EForm - 2148
V1
HELP
Complete and use the button at the end to print for mailing.
SISSETON-WAHPETON OYATE
MONTHLY CIGARETTE SALES REPORT
Mail to: Department of Revenue, Special Tax Division, 445 E Capitol Ave Pierre, SD 57501-3100
Cigarettes sold in the month of _______________________________, 20_____
Licensed tobacco distributors are required to file a monthly report of the number of cigarette packs
sold to retail locations listed below.
The report shall show the number of cigarette packs sold to the following retailers:
Number of 20 cigarette packs
Number of 25 cigarette packs
Dakota Connection Casino/Convenience Store/Filling
Station
Agency Village Convenience Store/Filling Station
Dakota Sioux Hotel/Casino/Convenience Store/Filling
Station
TOTAL NUMBER:
0
0
I, the undersigned, certify that this return is an accurate and true report of all packs of cigarettes 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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Parent category: Financial
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