Form 1946 - South Dakota Cheyenne River Indian Reservation Otp Sales

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SD EForm - 1946
V1
Complete and use the button at the end to print for mailing.
CHEYENNE RIVER INDIAN RESERVATION – OTP SALES
MONTH OF ______________________________
MAIL TO: SD DEPARTMENT OF REVENUE, 445 E CAPITOL AVE, PIERRE, SD 57501-3185
Licensed tobacco distributors are required to file a monthly report of tobacco products (other than cigarettes) sold to retailers located on the
Cheyenne River Indian Reservation.
The report shall show the dollar amount of OTP sales to retailers within the following:
DUPREE:
$_______________________________
EAGLE BUTTE:
$_______________________________
ISABEL:
$_______________________________
TIMBER LAKE:
$_______________________________
FIRESTEEL:
$_______________________________
GLENCROSS:
$_______________________________
TRAIL CITY:
$_______________________________
WHITE HORSE:
$_______________________________
LA PLANT:
$_______________________________
RIDGEVIEW:
$_______________________________
PARADE:
$_______________________________
LANTRY:
$_______________________________
GLAD VALLEY:
$_______________________________
REDELM:
$_______________________________
RURAL DEWEY COUNTY:
$________________________________
RURAL ZIEBACH COUNTY:
$________________________________
0.00
TOTAL DOLLAR AMOUNT SOLD:
$_________________________________
I, the undersigned, certify that this return is an accurate and true report of the dollar amount of tobacco products (other than cigarettes) sold
by our company on the Cheyenne River Indian Reservation.
Signed: __________________________________________________________________________________________________________________
Licensee Name: __________________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
th
NOTE: This report is due by the 10
of each month.
PRINT FOR MAILING
CLEAR FORM

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