Occupational Tax Application - Banks County
ADVERTISEMENT
1
2
3FOR GOVERNMENT USE ONLY
TAX YEAR
SAVE Affidavit ______
BANKS COUNTY, GEORGIA
BUSINESS OCCUPATION TAX APPLICATION
CERTIFICATE #
E-verify # ___________
NEW BUSINESS: DUE BEFORE COMMENCING OPERATION
NAICS CODE
Effective Date ______
ST
RENEWAL: DUE ON OR BEFORE JANUARY 1
REMIT TO:
BANKS COUNTY
AMOUNT PAID
COMMISSIONERS OFFICE
150 HUDSON RIDGE
DATE
CR #
SUITE 1
HOMER, GA 30547
CK #
CA
CC
TELEPHONE: (706)677-6800
SEE PAGES 2-3 FOR INSTRUCTIONS
COMPLETE ALL SECTIONS
1.
BUSINESS CORPORATE NAME
9. BUSINESS MAILING ADDRESS
_______________________________________________________
ADDRESS
ADDRESS__________________________________________________
_______________________________________________________
PHONE______________________
EMAIL_____________
CITY, STATE, ZIP____________________________________________
2. BUSINESS TYPE
10. BUSINESS “DOING BUSINESS AS” & LOCATION”:
CORPORATION
LLP
PARTNERSHIP
LLC
NON-PROFIT
SOLE OWNER
NAME_____________________________________________________
3. TYPE OF REGISTRATION
ADDRESS__________________________________________________
NEW
DATE OPENED________________________
CITY, STATE, ZIP____________________________________________
RENEWAL
PHONE ___________________________________________________
CLOSED
DATE CLOSED________________________
E-MAIL ___________________________________________
4. FEDERAL TAX ID NUMBER
11. STATE LICENSE #
EXPIRATION DATE
(if applicable)
5. STATE SALES TAX NUMBER
___________________________
___________________
12. E-VERIFY #
EFFECTIVE DATE
(required for more than 10 employees)
6. IS BUSINESS LOCATED IN YOUR HOME OR ON YOUR PROPERTY
___________________________
___________________
LOCATED IN BANKS COUNTY?
YES
NO
13. GENERAL INFORMATION:
7. FULLY DESCRIBE NATURE OF BUSINESS
List arrests, convictions, and Municipal or County Ordinance violations for
owner, officer, partner and manager of business:
(Additional space on back of page
1)
________________________________________________
8. OWNERS AND/OR OFFICERS INFORMATION
(Additional space on back of
________________________________________________
page 1)
________________________________________________
NAME/TITLE________________________________________________
14. I CERTIFY that the figures given as a basis for taxation are true and correct to
the best of my knowledge, and that records shall be available for inspection as
specified in Sec. 22-56 of the Banks County Code. I further certify that the zoning
HOME ADDRESS__________________________________________
classification of the property located at the business address above is appropriate
zoning to permit the business use at such location and that the building to be used at
such business location currently is, or will be prior to occupancy, in compliance with
CITY, STATE, ZIP__________________________________________
all building codes applicable to such business. I understand that issuance of
Occupation Tax Certificate/License does not indicate conformity with Banks County
ordinances and it is my/our responsibility to conform to all ordinances. Banks
HOME PHONE #__________________________________________
County expressly reserves the right to enforce any and all ordinances regardless of
payment.
NAME/TITLE________________________________________________
Signature___________________________________________________
HOME ADDRESS__________________________________________
Title__________________________
Date_________________________
15. GENERAL BUSINESS AND ADMINISTRATIVE FEE
CITY, STATE, ZIP_________________________________________
HOME PHONE #__________________________________________
-SEE FOLLOWING PAGE-
Page 1 of 3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial