Farm Winery Affidavit

AFFIDAVIT STATE OF SOUTH DAKOTA COUNTY OF ) )ss ) ________________________, being first duly sworn on oath deposes and says: That on the ____ day of _______________, 20___ he/she held a South Dakota farm winery license for __________________________ in the city/county of ______________, South Dakota and that pursuant to SDCL 35-12-4: (1) South Dakota produced or grown product is not available in quantities sufficient to constitute a majority of the wine produced by the farm winery. In particular, the following product is not available (choose all that apply): ____ grapes ____ grape juice ____ other fruits ____ honey (2) It is requested that the Secretary of the Department of Revenue approve the use of imported grapes, grape juice, other fruits, and/or honey for a period of one year from the date of his approval of this request. _______________________________ (licensee) Subscribed and sworn to before me this ___ day of _____________, 20___. _______________________________ Notary Public Commission Expires: __________________ (SEAL) American LegalNet, Inc. www.FormsWorkFlow.com