Instructions:

Please call and make an appointment with a Revenue agent to audit your loss claim.

Rapid City - (605)-394-2332; Sioux Falls - (605)-367-5800; Pierre - (605)-773-3311.

Your Revenue Agent will confirm the can, case or bottle count only. The both of you will then sign and date the form. This completed form will be emailed by the Revenue Agent to SpecialT@state.sd.us.

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South Dakota Department of Revenue

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