Form St-C 214-1 - Nonresident Contractor'S Application For Authorization To Perform - Georgia Department Of Revenue

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ST-C 214-1 (REV.8/12)
Georgia Department of Revenue
This application is not to be construed
Sales Tax Contracting Unit
1800 Century Blvd. NE
to discharge any obligation, bonded or
Atlanta, GA 30345
otherwise imposed by section 48-8-6
3
Phone: 1- 877-423-6711
Only original bonds, signed & notarized
Fax: (404) 417-6610
can be accepted. Bond not accepted for
E-mail:
TSD-sales-tax-contractors@dor.ga.gov
contracts less than $10,000.
Website:
etax.dor.ga.gov
N
C
’
A
A
P
ONRESIDENT
ONTRACTOR
S
PPLICATION FOR
UTHORIZATION TO
ERFORM
Contract or Job Number: ________________________
Beginning Date of Activity:
STN:
Date of Release
(for Department use only):
Bond Number:
Name of Business:
Street Address:
City:
State:
ZIP Code:
Individual
Partnership
Corporation
Other
Type of Ownership:
Person For Whom Contract is to be Performed:
Street Address:
City:
State:
ZIP Code:
Job Location:
City:
County:
Type of Contract Work to be Performed:
Beginning Date:
Anticipated Date of Job Completion:
Total Cost of Contract:
In order for your application to be processed, please include the $10 registration fee and Bond at 10% of the
contract price.
Application must be completed in full and remittance enclosed
[ ] Cashier Check
[ ] Certified Check
Type of Remittance:
[ ] Postal Money Order
Signature ____________________________________
(Signature of Owner or Partners. If Corporation, Authorized Officer must sign.)
Printed Name _________________________________
Title _________________________________________
Email _______________________________________
Contact name _________________________________
Contact phone number __________________________

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