Form Crf-002 - State Tax Registration Application Page 3
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CRF-002
Form
(Rev. 2/13)
Responsible Party Information
Step 1
Read this information first
Under section 48-2-52 of the Official Code of Georgia Annotated, a:
corporation officer or employee,
limited liability company member, manager or employee, or
limited liability partnership, partner or employee
may be held personally liable for unpaid sales tax, withholding tax, and 911 charges on prepaid wireless services assessed against such
corporation, limited liability company, or limited liability partnership.
The responsible party information
be completed for each of the persons described above who is under a duty to collect, account for
and pay any of the above-described taxes or amounts to the Department of Revenue.
The responsible party information
also be used to notify the Department of Revenue when there is a change in responsible persons.
Attach additional pages if needed.
Step
2
Identify the business registered or to be registered for any of the tax types or charges listed in Step 1
Business Name
Business Address
Federal Employer Identification Number
Daytime Telephone Number
Date
Name of person completing this form
Title
Step 3
Identify the person(s) responsible for filing your business' returns and/or paying all tax or charges due
First Name
Middle Initial Last Name
Job Title
Social Security Number
Mailing Address (
number, street, and room or suite no.)
City
State
ZIP code
Phone Number
Enter dates when responsibility begins and ends (if applicable):
Email Address
From:
To:
Check all for which person is responsible:
Sales and Use Tax
Withholdin
g
T
a
x
911 Charges on Prepaid Wireless Services
Complete the following if you need to identify
another person
First Name
Middle Initial Last Name
Job Title
Social Security Number
Mailing Address (
number, street, and room or suite no.)
City
State
ZIP code
Phone Number
Enter dates when responsibility begins and ends (if applicable):
Email Address
From:
To:
Check all for which person is responsible:
Sales and Use Tax
Withholdin
g
T
a
x
911 Charges on Prepaid Wireless Services
Complete the following if you need to identify another person
First Name
Middle Initial Last Name
Job Title
Social Security Number
Mailing Address (
number, street, and room or suite no.)
City
State
ZIP code
Phone Number
Enter dates when responsibility begins and ends (if applicable):
Email Address
From:
To:
Check all for which person is responsible:
Sales and Use Tax
Withholdin
g
T
a
x
911 Charges on Prepaid Wireless Services
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Parent category: Financial