SD EForm - 0885 V1 South Dakota Department of Revenue Distilled Spirits and Wine Tax Report Mail to: Special Tax Division, Department of Revenue, 445 E. Capitol Avenue, Pierre, SD 57501-3100 Name: ______________________________________________________ Address: ____________________________________________________ City & State: _________________________________________________ (Zip Code) License No.: _____________________________________________________ Month of: _______________________________________________________ Phone No.: ______________________________________________________ PART A For columns (a through e) LIST TOTAL WINE GALS. (a) Wine and Diluted Bev. Except Spkg. 3.2% - 14% $.93 (b) Cider $.28 (c) Wine Except Spkg. 14.1% - 20% $1.45 (d) Spkg. Wines 20.1% - 24% $2.07 (e) Distilled Spirits and other Diluted Bev. $3.93 1. 2. 3. 4. 5. INVENTORY (beginning of month) INVENTORY (end of month) SALES DURING MONTH (Gallons) RECEIPTS AND IMPORTS DEDUCTIONS a. Returned to Mfg. b. Breakage (carrier, warehouse, delivery) c. New Placements d. Stockholders Off. withdrawals e. Tax Paid Purchases 6. 7. TOTAL DEDUCTIONS (Add 5a,b,c,d,e) NET TAXABLE (line 4 minus line 6) 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 PART B ­ Tax Computation: a. b. c. d. e. f. Wine ­ 3.2% - 14%..............................(Column a, line 7)..............................Gals. x $.93 = Cider................................................(Column b, line 7)..............................Gals. x $.28 = Wine ­ 14% - 20%...............................(Column c, line 7)...............................Gals. x $1.45 = Wine ­ 20% - 24%; All Spkg. Bev. ...........(Column d, line 7)...............................Gals. x $2.07 = All Other Wines and Spirits.....................(Column e, line 7)...............................Gals. x $3.93 = $0.00 Total purchase price of alcoholic beverages, Part C $ _________________________________ x 2% = g. h. i. Total Tax Due (total line a through line f) .................................................................... Penalty ............................................................................................................ Total Tax and Penalty Due ..................................................................................... $ $ $ $ $ $ $ $ $ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Report MUST be filed with full payment on or before the 25th of the second month following report period. I declare under the penalty of perjury that this report has been examined by me and to the best of my knowledge and belief is a true, correct and complete report. Signature of Licensee Signature of Preparer Date (FOR OFFICE USE) A.B. Purchase Price Fund No. 4003 $ SD Rev. SPT ­ 103 - 98 Liquor Tax No. 0087 $ American LegalNet, Inc. www.FormsWorkFlow.com PART C (a) Wine and Dil. Bev. except Spkg. 3.2 - 14% Date Received Invoice Number Supplier Wine Gals. (b) Cider Alcoholic Beverages Received During Month and Purchase Price (c) Wine except Spkg. 14.1 - 20% Wine Gals. Wine Gals. (d) Spkg. Wine 20.1 - 24% Wine Gals. (e) Distilled Spirits and other Diluted Bev. Wine Gals. (f) 2% Purchase Price 2% Purchase Price TOTALS 0.000 0.000 0.000 0.000 0.000 $0.00 PURCHASED FROM WHOLESALERS WITHIN THE STATE (detail for line 5e) TOTALS 0.000 0.000 1. 0.000 0.000 0.000 $0.00 American LegalNet, Inc. www.FormsWorkFlow.com