Last updated: 1/25/2024
Report Of Alcohol Berverage Violation And Notice Of Conviction
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Description
SD EForm - 0876 V1 STATE OF SOUTH DAKOTA DEPARTMENT OF REVENUE REPORT OF ALCOHOL BEVERAGE VIOLATION AND NOTICE OF CONVICTION Date of Conviction City County Name of Person Convicted Address City Zip Code SDCL Section Violated BUSINESS INFORMATION Name of Business Where Violation Occurred Date of Offense Address of Business Where Violation Occurred City Zip Code Dated this ____________ day of _________________________, 20_____________ (Seal) ___________________________________________________________________ Signature of Clerk of Court or Authorized Representative Please Mail along with a Certified Copy of the Judgment or Sentence To: Department of Revenue Special Tax Division 445 East Capitol Avenue Pierre, SD 57501 American LegalNet, Inc. www.FormsWorkFlow.com
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