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Form St-C 214-7 Gc - Notice Of Prime Or General Contractor Of Funds Withheld Pending Request Of A Release Notice

ST-C 214-7 GC (Rev. 7/06)

Georgia Department of Revenue

Sales Tax Contracting Unit

1800 Century Blvd. NE, Suite L-200

Atlanta, GA 30345

(404) 417-4490

Fax: (404) 417-4313

E-mail:

TSD-sales-tax-contractors@dor.ga.gov

Website:

NOTICE OF PRIME OR GENERAL CONTRACTOR

OF FUNDS WITHHELD PENDING REQUEST OF A RELEASE NOTICE

This form is ONLY to be submitted 60 days following the subcontractor’s sales and use tax reporting

period upon completion of each phase of the work:

This is to certify that the undersigned is holding in escrow funds on work performed by the named Sub-

Contractor under the requirements of Section § 48-8-63 of the Official Code of Georgia Annotated:

1. Sub-Contractor’s Name

2. Address

3. Job Location

4. Period Work was in Progress

5. Nature of Work Performed

6. Contract Number

(REQUIRED)

7. Amount of Contract

8. Amount of Retainage

___________________________________________

(Prime or General Contractor)

___________________________________________

Date _______________________

(Signature)

___________________________________________

(Address)

___________________________________________

(E-mail Address)

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Form St-C 214-7 Gc - Notice Of Prime Or General Contractor Of Funds Withheld Pending Request Of A Release Notice