Form Crf-002 - State Tax Registration Application - Georgia Department Of Revenue - 2002 Page 2
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1
2(Please Read Instructions Before Completing)
OWNERSHIP / RELATIONSHIP SECTION
(This section MUST be completed for your application to be accepted.)
15
CHECK ALL THAT APPLY
Owner
Parent Company
Manager
Related Business
Partner
Shareholder
Tobacco Licensee
Motor Fuel Supplier
Officer
Alcohol Licensee
Tobacco Distributor
Managing Member
A
BUSINESS NAME
STI or LICENSE NO.
B
GA SALES TAX NO.
GA WITHHOLDING TAX NO.
LAST NAME
FIRST
M.I.
TITLE
SOCIAL SECURITY NO.
C
ADDRESS
D
E
CITY
STATE
ZIP
COUNTY
COUNTRY
PHONE
16
CHECK ALL THAT APPLY
Owner
Parent Company
Manager
Related Business
Partner
Shareholder
Tobacco Licensee
Motor Fuel Supplier
Officer
Alcohol Licensee
Tobacco Distributor
Managing Member
A
BUSINESS NAME
STI or LICENSE NO.
B
GA SALES TAX NO.
GA WITHHOLDING TAX NO.
C
LAST NAME
FIRST
M.I.
TITLE
SOCIAL SECURITY NO.
D
ADDRESS
CITY
STATE
ZIP
COUNTY
COUNTRY
PHONE
E
(TO REPORT ADDITIONAL RELATIONSHIPS, USE FORM CRF-004)
SALES AND USE TAX SECTION
17
NATURE OF BUSINESS (If combination of two or more, list approximate percentages of receipts. Must equal 100%.)
Retail
%
Services
%
Manufacturing
%
Mining
%
Wholesale
%
Construction
%
Processing
%
Other
%
WHAT KIND OF BUSINESS WILL YOU OPERATE? (Be specific as to the product sold or service provided.)
18
19
WILL YOU SELL ALCOHOLIC BEVERAGES?
Yes
No
/
/
20
WILL YOU SELL RETAIL TOBACCO PRODUCTS?
Yes
No
Date
21
WILL YOU SELL GASOLINE AND/OR MOTOR FUEL?
Yes
No
If “Yes”, please specify the name of
The dealer responsible for paying the tax on gasoline and/or motor fuel sales, if other than yourself.
NAME
SALES TAX NO.
22
WHEN DID OR WILL YOU START SELLING OR PURCHASING ITEMS SUBJECT TO SALES TAX?
/
/
Date
23
WHAT ACCOUNTING METHOD WILL YOU USE?
Cash Basis
Accrual Basis
24
WILL YOU HAVE EMPLOYEES?
Yes
No
If “Yes”, complete the following WITHHOLDING TAX
SECTION. If “No”, stop here and complete Signature Section.
WITHHOLDING TAX SECTION
25
WHO WILL BE RESPONSIBLE FOR FILING AND REMITTING THE PAYROLL TAXES FOR YOUR EMPLOYEES?
Applicant or Payroll Service Bureau
Other
If “Other”, list the name and GA. Withholding No. of the business responsible for paying these taxes.
NAME
GA. WITHHOLDING TAX NO.
26
DO YOU EXPECT TO WITHHOLD MORE THAN $200 PER MONTH?
Yes
No
27
HOW MANY EMPLOYEES DOES THIS BUSINESS HAVE OR WILL HAVE?
/
/
28
DATE ON WHICH WAGES WERE OR WILL FIRST BE PAID?
Date
SIGNATURE SECTION
I HAVE EXAMINED THIS APPLICATION, AND TO THE BEST OF MY KNOWLEDGE IT IS TRUE AND CORRECT
Signature
Title
Date
(MUST BE SIGNED BY OWNER, PARTNER, OR CORPORATE OFFICER AS LISTED IN THE RELATIONSHIP SECTION ABOVE.)
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