Occupational Tax Certificate Return Form - City Of Dalton - 2016
ADVERTISEMENT
1
22016 OCCUPATIONAL TAX CERTIFICATE RETURN
City Of Dalton, Georgia
City Clerk’s Office
For Office Use Only
300 West Waugh Street #317
Customer Number: ______________
Post Office Box
1205
Dalton, Georgia
30722-1205
ID Number: ______________
Phone (706)529-2490 | Fax (706)529-2491
S
E
C
T
I
O
N
I
-
P
L
E
A
S
E
A
N
S
W
E
R
Q
U
E
S
T
I
O
N
S
1
–
1
0
S
E
C
T
I
O
N
I
-
P
L
E
A
S
E
A
N
S
W
E
R
Q
U
E
S
T
I
O
N
S
1
–
1
0
(1) Is Business Located in the city limits?
Yes
No
(2) Is This Return A
New Return
Renewal Return
Change In Existing Account
(3) Does This Business have an Occupational Tax Certificate in Another City in Georgia
Yes
No Where? __________
(4) The Business Classification is
Regular (i.e. store)
Professional (i.e. Doctor)
Bank
(5) Is This Business
Permanent
Seasonal
Temporary
(6) If Professionals, Check the Appropriate Method of Payment
Per Employee Method
Per Practitioner Method
(7) Is Building Newly Constructed?
Yes
No Date ___________
(8) Has Building been Remodeled or Renovated?
Yes
No Date ___________
(9) Is Business Out of Business?
Yes
No
(10) What Date Did Business Go Out of Business? ____/_____/________
-
-
S
E
C
T
I
O
N
I
I
P
L
E
A
S
E
C
O
M
P
L
E
T
E
T
H
E
F
O
L
L
O
W
I
N
G
A
C
C
O
R
D
I
N
G
L
Y
S
E
C
T
I
O
N
I
I
P
L
E
A
S
E
C
O
M
P
L
E
T
E
T
H
E
F
O
L
L
O
W
I
N
G
A
C
C
O
R
D
I
N
G
L
Y
OWNER NAME
(Corporate Name Or Individual Owner):
D/B/A
(Name Of Business):
STREET ADDRESS
(Local Address of Business):
MAILING ADDRESS:
Same as Street Address
CITY:
STATE:
ZIP:
BUSINESS TELEPHONE:
FAX:
CONTACT PERSON:
CONTACT TELEPHONE:
S
S
E
E
C
C
T
T
I
I
O
O
N
N
I
I
I
I
I
I
-
-
C
C
H
H
E
E
C
C
K
K
T
T
H
H
E
E
A
A
P
P
P
P
R
R
O
O
P
P
R
R
I
I
A
A
T
T
E
E
C
C
A
A
T
T
E
E
G
G
O
O
R
R
Y
Y
CHECK THE TYPE OF BUSINESS TO BE CONDUCTED AT THIS LOCATION, IF BUSINESS TYPE IS NOT LISTED PLEASE LIST
Apartment
Beauty/Barber Shop
Manufacturer
Store/Merchant
Auto Dealer
Hotel/Motel
Restaurant
Taxi
Bank
Consultant
Service
Other __________________________
S
E
C
T
I
O
N
I
V
-
L
I
S
T
T
H
E
N
U
M
B
E
R
O
F
E
M
P
L
O
Y
E
E
S
S
E
C
T
I
O
N
I
V
-
L
I
S
T
T
H
E
N
U
M
B
E
R
O
F
E
M
P
L
O
Y
E
E
S
NEW BUSINESSES ONLY
RENEWAL ONLY
Please List The Number of Employees Employed
Please List The Number of Employees Employed
In The Business As Of The Date of This Return
In The Business As Of JANUARY 1, 2015
Employees = Persons on the payroll As of This Time
Employees = Persons on payroll As of 1/1/2015
If There Are No Employees - List Zero In The Box
Renewals Are Billed On The Previous Years Employees
S
S
E
E
C
C
T
T
I
I
O
O
N
N
V
V
-
-
P
P
R
R
O
O
V
V
I
I
D
D
E
E
A
A
S
S
R
R
E
E
Q
Q
U
U
I
I
R
R
E
E
D
D
Georgia Sales Tax Number
: _______________________
NAICS Number: ______________________
(If applicable)
-
-
S
E
C
T
I
O
N
V
I
R
E
A
D
C
A
R
E
F
U
L
L
Y
B
E
F
O
R
E
S
I
G
N
I
N
G
S
E
C
T
I
O
N
V
I
R
E
A
D
C
A
R
E
F
U
L
L
Y
B
E
F
O
R
E
S
I
G
N
I
N
G
This Return Is Due In The Clerk’s Office on or before the 15
th
of November of each year before a statement or certificate can be issued. Failure to File this
th
Return by the 15
of November will result in penalty. I certify that the foregoing information is true and correct. I understand that falsification of this
return could cause denial of a certificate without refund.
_____/_____/_____________
_________________________________________________
Continued. .
Date
Signature
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial