Sd Eform 0890 - Brewers Monthly Report Of Sales Of High Point Beer And Low Point Beer (3.2) Sold To South Dakota Wholesale Licensees

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SD EForm -

0890

Brewers Monthly Report of Sales of High Point Beer

and Low Point Beer (3.2) sold to South Dakota Wholesale Licensees

South Dakota Department of Revenue

Special Taxes Division, 445 East Capitol Avenue, Pierre, SD 57501-3100

Name of Brewer ____________________________________________________________ Address ________________________________________________

Month of _______________________, 20_________

________________________________________________

To whom shipped and

Invoice

Date

3.2%

12/12

12/32

12/25

24/7

12/40

24/10

24/12

24/16

35/7

36/7

36/8

48/7

32/7

For Office Use Only

Address

No.

or H.P.

bbl

(Report Must be Submitted for the previous month’s business by the 15

of the following month)

State of _______________________________________

County of _____________________________________

On this day personally appeared before me, the undersigned, who being duly sworn, states that he has read this report and accompanying schedules and that the statements contained

herein are true and correct.

Sworn to and subscribed before me this ___________ day of ___________________ 20________

______________________________________________________________

____________________________________________________ Notary Public

___________________________________________________________Title

SPT 110

PRINT FOR MAILING

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