SPT Revised South Dakota Cigarette Stamp Order Blank Receipt Form

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SPT Revised South Dakota Cigarette Stamp Order Blank Receipt Form Powered By Docstoc
					SPT-306 Revised 06/07

South Dakota Cigarette Stamp Order Blank & Receipt Form
South Dakota Department of Revenue & Regulation
445 E. Capitol Avenue | Pierre, SD 57501-3185 | 1-800-TAX-9188

Part I Information
TD Li cense Number D i stri butor's Name Mai li ng Address C i ty State Zi p C ode D ate Telephone Number

Part II Order Form
Type of Stamps Stamps per Uni t 150 per sheet 30,000 per roll $ $ Rate per Uni t 229.50 x 45,900.00 x Uni ts Requested Value of Stamps =$ =$

Packs of 25

Packs of 20

A-heat appli ed (10 x 15 sheets)

Part I B-heat applied Information
C -heat appli ed (10 x 15 sheets)

150 per sheet

$

288.00 x

=$

Make Remittance payable to the SD State Treasurer or the SD Department of Revenue & Regulation

Distributor will be billed for the cost of heat applied to stamp paper.

Total Value of Stamps Less 2% discount Subtotal Less Credit Memo # Total Amount of Remittance

$ ________________ $ ________________ $ ________________ $ ________________ $ ________________

Signature of Distributor or Authorized Agent _________________________________________________________________

Part III Receipt
Type of Stamp

For Department of Revenue & Regulation Use Only
# of Uni ts i ssued Seri al Numbers of stamps i ssued

Total Amount of Remittance received

$ _______________________

Signature of Authorized Issuing Agent ____________________________ Date ____________________________________ Signature of person receiving stamps (if physical delivery) ______________________________________________________

Part IV Receipt
Distributor completes Part I & II - keeping the pink copy for their records. SEND THE WHITE AND YELLOW COPY TO:
SD Department of Revenue & Regulation Special Tax Division 445 East Capitol Avenue Pierre, SD 57501-3185
YELLOW COPY - DRR - to be returned with stamps PINK COPY - Licensee

WHITE COPY - SD Department of Revenue & Regulation