Sd Eform 1776 - Out-Of-State Cigarette Distributors' Monthly Report - South Dakota Department Of Revenue
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1SD EForm - 1776
V1
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Complete and use the button at the end to print for mailing.
Out-of-State Cigarette Distributors’ Monthly Report
Mail to: South Dakota Department of Revenue & Regulation, Special Tax Division, 445 E Capitol Ave, Pierre, South Dakota 57501-3100
(605) 773-3311
Name __________________________________________License No. _____________________________
Address ________________________________________ County _________________________________
City or Town ____________________________________ State ___________________________________
Month Ending _______________________ , 20_________ Phone No. _______________________________
This report must be filed with the Department of Revenue & Regulation, Pierre, South Dakota, by the 15th day of the month following
the period for which this report is filed.
RECORD OF STAMPS PURCHASED AND USED
1. Inventory of stamps at beginning of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ _______________
0.00
2. Affixed @ $0.53 . . . . . . . . . . . . . . . . . . . . No._________. . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
3. Affixed @ $0.67. . . . . . . . . . . . . . . . . . . . .No._________ . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
4. Unaffixed stamps @ $0.53 (20/pkg) . . . . . No._________ . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
0.00
5. Unaffixed stamps @ $0.67 (25/pkg). . . . . . No._________ . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
6. Stamps purchased @ $0.53 during month . .No.________ . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
0.00
7. Stamps purchased @ $0.67 during month . .No.________ . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
8. Total value of stamps (lines 1, 6 and 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
9. Inventory of stamps at END of month . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ _______________
0.00
10. Affixed @ $0.53 (20/pkg) . . . . . . . . . . . No.__________. . . .. . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
11. Affixed @ $0.67 (25/pkg) . . . . . . . . . . . No.__________. . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
12. Unaffixed stamps @ $0.53 (20/pkg) . . . .No.__________. . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
13. Unaffixed stamps @ $0.67 (25/pkg) . . . .No.__________ . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
14. Total value of inventory (lines 10, 11, 12 and 13). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
15. Balance to be accounted for (line 8 less line 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
16. Total cigarettes sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
0.00
17. Tax on cigarettes sold (as shown on line 16) at rate of 26.5 mills per cigarette (line 16 x 0.0265)$ _______________
0.00
18. Short or over (difference between lines 15 and 17). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________
I hereby certify that, to the best of my knowledge and belief, the within and foregoing report is true, correct and complete
and that no cigarettes have been sold or disposed of, nor stamped, contrary to the provisions of SDCL 1967 10-50.
Dated this _______day of ______________ , 20________
__________________________________
Signature of Manager or Official
SD REV SPT 304 (3-03)
PRINT FOR MAILING
EXIT
CLEAR FORM
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