Form St-C-214-2 - Application For Non-Resident Subcontractor'S Sales And Use Bond - Georgia Department Of Revenue

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ST-C-214-2 (REV. 3/13)
Georgia Department of Revenue
Taxpayer Services Division
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
APPLICATION FOR NON-RESIDENT SUBCONTRACTOR’S SALES AND USE BOND
1. BUSINESS TRADE NAME
_______________________________________________________________________________________________
2. NAME OF OWNER(S) OR CORPORATE OFFICERS
TITLE
SOCIAL SECURITY NUMBER
__________________________________________
_______________
__________________________
__________________________________________
_______________
__________________________
3. MAILING ADDRESS (NUMBER AND STREET or P.O. BOX)
_______________________________________________________________________________________________
CITY:
STATE:
ZIP CODE:
4. BUSINESS ADDRESS (NUMBER AND STREET or P.O. BOX)
_______________________________________________________________________________________________
CITY:
STATE:
ZIP CODE:
5. TYPE OF BUSINESS
7. FEDERAL EMPLOYER IDENTIFICATION NUMBER OR
6. BEGINNING DATE OF CONTRACT WORK FOR WHICH THE
SALES TAX NUMBER
ATTACHED BOND IS EXECUTED
8. EMAIL ADDRESS (IF APPLICABLE)
9. AREA CODE AND TELEPHONE NUMBER
10. ANTICIPATED ANNUAL GROSS RECEIPTS FOR THIS
11. DATE
CALENDAR YEAR:
$_________________
Bond not accepted for annual gross receipts less than $250,000.
Applicant agrees to pay all taxes and to otherwise comply with all of the provisions of the Georgia Retailers’ and Consumers’ Sales and
Use Tax Act, as amended and file all returns and reports required by the State Revenue Commissioner.
Applicant further agrees to comply with all the rules and regulations of the State of Georgia now in existence or hereinafter promulgated
in the future with reference to the Georgia Retailers’ and Consumers’ Sales and Use Tax Act, as amended.
Applicant hereby designates ____________________________________________________________________________________
(Name)
of _________________________________________________________________________________________________________
(Address)
as the person upon whom service of any notice or process may be served against the applicant.

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