"South Dakota Tobacco P.a.c.t. Act Report" - South Dakota

South Dakota Tobacco P.a.c.t. Act Report is a legal document that was released by the South Dakota Department of Revenue - a government authority operating within South Dakota.

Form Details:

  • Released on March 1, 2013;
  • The latest edition currently provided by the South Dakota Department of Revenue;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the South Dakota Department of Revenue.

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South Dakota Tobacco P.A.C.T. Act Report
ate Tobacco P.A.C.T. Ac
t Report
Step 1: Identify your business
Name:
Reporting period: __ __/__ __ __ __
_________________________________________________
(Month/Year)
Address:
License no.: ____________________________
_______________________________________________
Number and street
Federal Employer Identification number:____-______________
________________________________________________
City
State/Province
ZIP
(FEIN)
Country/Territory: ___________________________________
Phone: (_____)______- ___________ Ext:__________
Contact name: ______________________________________
Email address:___________________________________
S
tep 2:
Iden f
ti y your sales into South Dakota
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:_______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: __________________________________ Wholesale list price:__________________________
Buyer:
_____________________________
Address:________________________________ License #:____________________________________
________________________________ FEIN: ________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:_______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: ______________________________
Buyer:
_____________________________
Address:________________________________ License #:_____________________________________
________________________________ FEIN: ________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: ______________________________
Buyer:
_____________________________
Address:_______________________________ License #: ____________________________________
_______________________________ FEIN: _________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: ______________________________
Buyer:
_____________________________
Address:______________________________ License #: ______________________________________
______________________________ FEIN: __________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:_______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: _____________________________
Buyer:
_____________________________
Address:________________________________ License #: ____________________________________
________________________________ FEIN: ________________________________________
____________________________________________________________________________________
Step 3: Sign below
Under penalties of perjury, I state that I have examined this report, and, to the best of my knowledge, it is true, correct, and complete. I also
state that such information is taken from the books and records of the business for which this report is filed.
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Owner or officer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Preparer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
South Dakota Tobacco P.A.C.T. Act Report
ate Tobacco P.A.C.T. Ac
t Report
Step 1: Identify your business
Name:
Reporting period: __ __/__ __ __ __
_________________________________________________
(Month/Year)
Address:
License no.: ____________________________
_______________________________________________
Number and street
Federal Employer Identification number:____-______________
________________________________________________
City
State/Province
ZIP
(FEIN)
Country/Territory: ___________________________________
Phone: (_____)______- ___________ Ext:__________
Contact name: ______________________________________
Email address:___________________________________
S
tep 2:
Iden f
ti y your sales into South Dakota
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:_______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: __________________________________ Wholesale list price:__________________________
Buyer:
_____________________________
Address:________________________________ License #:____________________________________
________________________________ FEIN: ________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:_______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: ______________________________
Buyer:
_____________________________
Address:________________________________ License #:_____________________________________
________________________________ FEIN: ________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: ______________________________
Buyer:
_____________________________
Address:_______________________________ License #: ____________________________________
_______________________________ FEIN: _________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: ______________________________
Buyer:
_____________________________
Address:______________________________ License #: ______________________________________
______________________________ FEIN: __________________________________________
Date: ___ ___ /___ ___ /___ ___ ___ ___
Invoice:_______________________________________ Type:___ Total weight: ______ Quantity:__________
Brand:
_____________________________
UPC: _________________________________ Wholesale list price: _____________________________
Buyer:
_____________________________
Address:________________________________ License #: ____________________________________
________________________________ FEIN: ________________________________________
____________________________________________________________________________________
Step 3: Sign below
Under penalties of perjury, I state that I have examined this report, and, to the best of my knowledge, it is true, correct, and complete. I also
state that such information is taken from the books and records of the business for which this report is filed.
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Owner or officer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
_____________________________
________________________ (____)____-___________
____/____/________
Title:
Preparer’s signature and title (state if individual owner, member of firm, or corporate officer title)
Telephone number (include area code)
Date
General Information
Step-by-Step Instructions
What does the P.A.C.T. Act refer to?
Step 1: Identify your business
The Prevent All Cigarette Trafficking Act of 2009 is
License number – write the license number or other identifi-
c
ommonly referred to as the PACT Act. Senate Bill 1147
cation number issued to you by the State of South Dakota.
was signed and became public law.
It is the purpose of this Act to:
Step 2: Identify your sales
• require Internet and other remote sellers of cigarettes
and smokeless tobacco to comply with the same laws
Type – write the number for each type of tobacco product you
that apply to law-abiding tobacco retailers;
a
re reporting:
• create strong disincentives to illegal smuggling of
Snuff = 1
Cigars
= 4
tobacco products;
Chew = 2
Roll your own tobacco = 5
• provide government enforcement officials with more
Pipe tobacco
= 3
Other
= 6
effective enforcement tools to combat tobacco
smuggling;
UPC – write the UPC for each product brand.
• make it more difficult for cigarette and smokeless
FEIN or License # – write the Federal Employers Identifica-
tobacco traffickers to engage in and profit from their
tion number (or Federal Identification number FTIN). If the
illegal activities;
buyer does not have either of these numbers, write the buyer's
• increase collections of Federal, State, and local excise
state tobacco
license number.
taxes on cigarettes and smokeless tobacco; and,
• prevent and reduce youth access to inexpensive
cigarettes and smokeless tobacco through illegal
Internet or contraband sales.
Who must file this report?
You must file this report if you advertise, offer for sale, sell,
transfer, or ship (for profit) smokeless tobacco in interstate
commerce. This smokeless tobacco must be shipped into an-
other state, locality, or Indian nation that taxes the sale or use
of smokeless tobacco.
When do I file?
The report is due no later than the 10th day of each
calendar month for the previous calendar month's
shipments.
Where do I send the report?
Mail to:
DOR Tobacco
Mickelson Building
1302 E. Hwy 14, Ste. 1
Pierre, SD 57501
Or
E-mail to:
DRR.Tobacco@state.sd.us
3/13
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