Form St-C 214- 5 - Notice Of General Or Prime Contractor Of Contract Let To A Subcontractor
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ST-C 214- 5 (Rev. 6 /12)
Georgia Department of Revenue
Sales Tax Contracting Unit
1800 Century Blvd. NE
Atlanta, GA 30345
1 (877) 423-6711
Fax: (404) 417-6610
E-mail:
TSD-sales-tax-contractors@dor.ga.gov
Website:
www. etax. dor.ga.gov
Notice of General or Prime Contractor of Contract Let to a Subcontractor
Each general or prime contractor shall file this form with the State of Georgia Revenue Commissioner
within thirty days after the execution of any contract or contract(s) with a subcontractor that are
for $250,000 or more for a resident or $10,000 or more for a non-resident on any single project.
1.________________________________________________________________________
(Name)
(If a partnership, also name the active partners)
________________________________________________________________________
(If a corporation, also name its Executive Officers)
2. __________________ _____________ _____ __________
_______________
(Street Number)
(City)
(State)
(ZIP Code)
(Area Code and Telephone Number )
3.________________________________________________________________________
(Kind of business engaged in)
4.________________________________________________________________________
(Name of Subcontractor)
5. __________________________ ___________________________ _____ __________
(Address of Subcontractor Street Number)
(City)
(State)
(ZIP Code)
6.________________________________________________________________________
(Nature of work to be performed)
(Indicates if labor contract only )
7.________________________________________________________________________
(Contract Number/Required)
8._______________ _____________ _____________ _____ __________ _____________
(Street Number)
(City)
(Where work is to be performed)
(State)
(ZIP Code)
(County)
9.________________________________________________________________________
(When work is to be performed)
10.________________________________________________________________________
(Total gross amount of the contract)
EXECUTED THIS _______ DAY OF _______________, 20_____.
______________________________
______________________________
(General or Prime Contractor)
(General or Prime Email Address)
______________________________
( Contact Number )
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