Form St-C-214-9 - Nonresident Contractor'S Consent To Service Of Process (Sole Proprietor)
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ST-C-214-9 (REV.5/12)
STATE OF GEORGIA
SECRETARY OF STATE
NONRESIDENT CONTRACTOR’S CONSENT TO SERVICE OF PROCESS
(SOLE PROPRIETOR)
KNOW ALL MEN BY THESE PRESENTS
That ________________________________________________________________________________
A Sole Proprietor, doing business as _________________________________________________ with its
principal office at
_____________________________________________________________________________________
for the purpose of complying with Section 4 of an Act of the General Assembly of the State of Georgia,
approved April 5, 1961 (Georgia Laws, 1961, pp. 480-484), does hereby irrevocably appoint the Secretary
of the State of Georgia, or his/her successor in office, as his/her true agent and lawful agent upon whom
may be served any summons or other lawful process in any action or proceeding against him/her for the
collection of all taxes, including contribution due under the employment security law, imposed by the State
of Georgia or any political subdivision thereof and growing out of the execution and performance of any
contract by him/her as a contractor as defined by the said Act; and the said Sole Proprietor does hereby
consent and agree that the service of the said process on the Secretary of State shall be of the same legal
force and validity as if due service had been made upon it within the State of Georgia; and the said Sole
Proprietor does hereby direct that the Secretary of State forward the said process to him/her at the
following address:
____________________________________________________________________________________
IN WITNESS WHEREOF, the Sole Proprietor has hereunto set his/her hand and affixed his/her seal this
_____day of_______________, 20____.
(STATE OF_________________)
ss.
(COUNTY OF _______________)
On this _____day of_______________, 20_____, before me, a notary public in and for said county and
State, personally appeared ________________________ and ________________________, to me
known to be the person described in and who executed the foregoing instrument and who, being by me
first duly sworn, did depose and say that he/she is the Sole Proprietor of the business described in the
foregoing instrument.
_____________________________,
Notary Public
(NOTARIAL SEAL)
My Commission Expires
_________________________
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