Application For Subcontractor'S Sales And Use Bond - 2003

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S & UT – 214-2 (Rev. 08/03)

Georgia Department of Revenue

Sales and Use Tax Division

Contract Section

1800 Century Center Blvd. NE Suite 8204

Atlanta, GA 30345-3205

(404) 417-6646

Clear Form

APPLICATION FOR SUBCONTRACTOR’S SALES AND USE BOND

Print Form

BUSINESS TRADE NAME

NAME OF OWNER(S) OR CORPORATE OFFICERS

TITLE

SOCIAL SECURITY NUMBER

_____________________________________________

________________

____________________________

_____________________________________________

________________

____________________________

MAILING ADDRESS

BUSINESS ADDRESS

KIND OF BUSINESS ENGAGED IN

BEGINNING DATE OF CONTRACT WORK FOR WHICH THE ATTACHED BOND IS EXECUTED

MM/DD/YY

AREA CODE AND TELEPHONE NUMBER

FEDERAL EMPLOYER’S IDENTIFICATION NUMBER

THE ANNUAL GROSS RECEIPTS FROM THE BUSINESS OF SUBCONTRACTING IN GEORGIA OR THE PRECEDING

CALENDAR OR FISCAL YEAR DID NOT EXCEED ____________ DOLLARS.

(12 MONTHS PERIOD COVERED ________________________________________________________.)

FOR A NEW SUBCONTRACTING BUSINESS: THE ANTICIPATED AMOUNT OF BUSINESS FOR THIS CALENDAR

YEAR 20 ______, IS NOT EXPECTED TO EXCEED ______________ DOLLARS.

__________________________________________________________________________________________

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.

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.

IN WITNESS WHEROF, Applicant has set his hand and affixed his seal this _______ day of _______________, 20______.

Sworn to and subscribed before me on

This _______ day of _______________, 20______ _______________________________________________________________________ (L.S.)

(Notary Public)