SDCL § 34-20-4: Poison register for schedule A poisons--Contents of entries.

No person shall furnish any poison named in schedule A to any person unknown to him, unless identified by one known to the seller, and unless he shall record in a well-bound book known as a poison register in the following form:

Date of Sale | Name of Poison or Preparation | Quantity | Purpose | Signature of Buyer or Person to Whom Delivered | Address | By Whom Introduced | By Whom Sold

the date of such sale, and the initials of the dispenser, the signature and address of the person to whom delivered, and the name of the person, if any, who introduced him, the name and quantity of the poison sold or furnished, and the purpose for which same is to be used.