Form 1972 - South Dakota Cigarette Distributors Monthly Report Revenue

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SD EForm - 1972
V1
HELP
Complete and use the button at the end to print for mailing.
Cigarette Distributors Monthly Report
Department of
R
evenue
This report must be filed with the Department of Revenue by the 15th day of the month following the
period for which this report is filed.
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$1.53 (20 pkg)
$1.92 (25 pkg)
1. Beginning Stamp Inventory (line 7 from previous month)
____________________
____________________
2. Stamps Purchased During Month
____________________
____________________
3. Cigarette Sales to SD (packages)
____________________
____________________
0
0
4. Ending Inventory (lines 1 + 2 - 3)
____________________
____________________
5. Affixed Stamps
____________________
____________________
6. Unaffixed Stamps
____________________
____________________
0
0
7. Ending Stamp Inventory (add lines 5 & 6)
____________________
____________________
RECONCILE
0
0
8. Line 7 from above: Stamp Inventory
____________________
____________________
0
0
9. Line 4 from above: Ending Inventory
____________________
____________________
0
0
10. Line 8 minus line 9: Short or Long Stamps
____________________
____________________
* Please explain short/long of over 100 stamps:
________________________________________________________________________________________________
________________________________________________________________________________________________
Distributors Located Within South Dakota - Please list sales to other States:
State Sold To:
20 pkg
25 pkg
______________________________________
___________________________ ___________________________
______________________________________
___________________________ ___________________________
______________________________________
___________________________ ___________________________
______________________________________
___________________________ ___________________________
______________________________________
___________________________ ___________________________
* Cigarettes should be reported in packages for all the above.
I hereby certify that, to the best of my knowledge and belief, this report is true, correct and complete and that no
cigarettes have been sold or disposed of, nor stamped, contrary to the provisions of SDCL 10-50.
Send completed form to:
Division of Special Taxes
445 E. Capitol Avenue
____________________________________________________________
Pierre, SD 57501
Signature of Owner or Manager
Date
Phone: 605-773-3311
Fax: 605-773-6729
PRINT FOR MAILING
CLEAR FORM

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