Form St-C-214-11 - Nonresident Contractor'S Consent To Service Of Process (Limited Liability Company)

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ST-C-214-11- (REV. 4/13)
Georgia Department of Revenue
Sales Tax Contracting Unit
1800 Century Blvd. NE
Atlanta, GA 30345
Phone: 1 (877) 423-6711
Fax: (404) 417- 6610
E-mail:TSD-sales-tax-contractors@dor.ga.gov
Website: https://etax.dor.ga.gov
STATE OF GEORGIA
SECRETARY OF STATE
NONRESIDENT CONTRACTOR’S CONSENT TO SERVICE OF PROCESS
(LIMITED LIABILITY COMPANY)
KNOW ALL MEN BY THESE PRESENTS:
That _________________________________________________________________________________________
a member, manager, or organizer of the limited liability company named ________________________________ with
its principal office at ______________________________________________________________________________
composed solely of him/herself and the following members and/or managers:
_____________________________________________________________________________________________
for the purpose of complying with Section 48-13-30 through 48-13-38 of the Official Code of Georgia Annotated does
hereby irrevocably appoint the Secretary of the State of Georgia, or his/her successor in office, as his/her and the said
limited liability company’s true and lawful agent upon whom may be served any summons or other lawful process in
any action or proceeding against him/her or the said company for the collection of all taxes, including contribution due
under the employment security law, imposed by the State of Georgia or any political subdivision thereof and growing
out of the execution and performance of any contract by him/her or the said Company as a contractor as defined by
the said Act; and he/she and the said company does hereby consent and agree that the service of the said process on
the Secretary of State shall be of the same legal force and validity as if due service had been made upon it within the
State of Georgia; and he/she and the said company do hereby direct that the Secretary of State forward the said
process to him/her and the said company at the following address:
____________________________________________________________________________________
IN WITNESS WHEREOF, the undersigned, for and in behalf of himself/herself and the said company, has caused
this instrument to be executed this _____day of_______________, 20____.
By:__________________________________________
Signature of member, manager, or organizer*
(STATE OF_________________)
__________________________________________
Print name and title (member, manager, or organizer)
(COUNTY OF_______________)
Sworn to and subscribed before me this _____day of_______________, 20_____.
(NOTARIAL SEAL)
_________________________________, Notary Public
My Commission Expires _________________________
*THIS FORM MUST BE SIGNED BY A MANAGER OR MEMBER (IF THERE IS NO MANAGER) OR AN
ORGANIZER (IF THERE IS NO MEMBER OR MANAGER).

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