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Form S & Ut - 214-7 - Notice Of Prime Or General Contractor Of Funds Withheld Pending Request Of A Release Notice

S & UT – 214-7 (Rev. 12/00)

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:

Sub-Contractor’ s Name

______________________________________________________

Address

______________________________________________________

Job Location

______________________________________________________

Period Work was in Progress ______________________________________________________

Nature of Work Performed

______________________________________________________

Amount of Contract

______________________________________________________

Amount of Retainage

______________________________________________________

___________________________________________

(Prime or General Contractor)

___________________________________________

Date _______________________

(Signature)

Georgia Department of Revenue

___________________________________________

Sales & Use Tax Division

(Address)

Contract Section

P.O. Box 38040

___________________________________________

Atlanta, GA 30334

Form S & Ut - 214-7 - Notice Of Prime Or General Contractor Of Funds Withheld Pending Request Of A Release Notice