SD EForm - 0869 V4 Revised 01/11 State of South Dakota Alcoholic Beverage Brand - Label Registration Application South Dakota Department of Revenue & Regulation Special Tax Division 445 E. Capitol Ave | Pierre, SD 57501-3100 Applicant Name: Mailing Address: Phone: Basic Federal Permit No.: Fax: E-mail Address: Application is hereby made for the registration of the Alcoholic Beverage Brand-Lables herein listed which will be offered for sale or held with intent to sell within the State of South Dakota in accordance with Chapter 39-13 and Section 10-1-14(4), South Dakota Compiled Laws for the calendar year: . CLASS NUMBER BRAND PRODUCT LABEL % Additional sheets may be attached if required FEE Total Fee: $ 0.00 I, the undersigned, an official of and for the above applicant, do hereby certify that the above products and labels conform to Laws $0.00 and Regulations of the State of South Dakota applicable to Alcoholic Beverages and have been registered with and approved by the Bureau of Alcohol, Tobacco and Firearms under the Federal Alcoholic Administration Act. Date Signed Title For Department Use Application Rec’d: License No: Total Registration Fee Rec’d: Additional Fee Due: Label Registrations Approved: Denied: Date: Exceptions: Signed: Special Tax Division, Department of Revenue SEE INSTRUCTIONS ON REVERSE SIDE SD REV SPT 201-01/11 American LegalNet, Inc. www.FormsWorkFlow.com Instructions Classifications (identify classifications by numbers) Registrations Fees Additional Initial Brand-Products Brand Labels Label 5 Wines* $25.00 $17.50 6 Malt and Cereal Beverages $25.00 $25.00 7 Distilled Spirits, Whiskeys, Gin, Rum, Brandy, Vodka, Alcoholic Cordials, Liqueurs, Cocktails, etc. $50.00 $50.00 NOTE: *The law provides for reduced registration fee when two or more brand labels of the same class of wine are registered by applicant. Note fees. Duplicate brand labels must be provided with this application. American LegalNet, Inc. www.FormsWorkFlow.com ALCOHOL BRAND REGISTRATION AND FEE GUIDE The South Dakota Department of Revenue considers the registered or common trade name of a given product the “brand name” and in many cases this does not mean the firms name uness it is the products actual registered brand or tradename. -EXAMPLECLASS NO. BRAND PRODUCTS % FEE 6 Hamms Beer - 25.00 6 Hamms Preferred Stock Beer - 25.00 5 Weibel Pinot Noir 11% 25.00 5 Weibel Chenin Blanc 11% 17.50 5 Harveys Gold Cap Port 20% 25.00 5 Harveys Hunting Port 20% 17.50 5 Lancers Rose 12% 25.00 5 Vinya Rose 12% 25.00 7 De Kuyper Kummel 70% 50.00 7 Duet Brandy Manhattan 40% 50.00 7 Party Tyme Margarita 25% 50.00 7 Party Tyme Screwdriver 25% 50.00 7 Seagram 7 Crown Blended Whiskey 86% 50.00 7 Seagram Extra Dry Gin 90% 50.00 7 House of Stuart Scotch Whiskey 80% 50.00 7 Hiram Walker Brandy No Age 80% 50.00 7 Crown House Vodka 80% 50.00 7 Old Busmills Irish Whiskey 86% 50.00 Total Fee: $685.00 Extensive listings may be filed by class on sheets attached to the application form and consolidated thereon by class if desired. American LegalNet, Inc. www.FormsWorkFlow.com Alcohol Brand Registration Information In order to market your alcohol beverage products in the State of South Dakota, they must be first filed and approved by the United States Department of Treasury, Bureau of Alcohol, Tobacco and Firearms. After federal approval, the following requirements are to be met for label approval in South Dakota. The following items must be provided by your office if you wish to qualify your company to register and ship alcoholic beverages into the State of South Dakota: 1. A copy of your product’s Federal Label Approvals 2. A copy of your product’s chemical analysis (if available) 3. Duplicate sets of labels for each brand product registered 4. Application for brand registration approved (done annually) 5. Proper brand registration fee attached to registration application 6. Affidavit from the registered brand owners for brand distribution authority if the brand registration applicant is not the owner thereof (NOTE: South Dakota requires that wholesalers receive alcoholic beverages only from the brand owner or his authorized agent.) 7. Copy of invoice of each shipment to our licensed alcoholic beverage wholesalers forwarded on a per shipment basis to this office 8. Brewers and beer importers must file a monthly report, SPT 110, of all shipments into South Dakota State liquor taxes are collected by the State at the wholesale level upon receipt by the wholesaler of all imported alcohol beverage products. Any sales person coming into South Dakota to sell your products would be required to obtain an annual alcoholic beverage solicitors license from this office and all alcohol beverage products must be sold to and through one of our in-state licensed alcohol beverage wholesalers. American LegalNet, Inc. www.FormsWorkFlow.com