Occupation Tax Return - The City Of Newnan Page 3

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Is business carried on at locations in Newnan other than the one listed above?

Yes

No If yes, list all locations (Attach a separate list if necessary)

Certification -- The information herein is required by the City of Newnan Code of Ordinances.

(TYPE

NAME) _________________________________________________ BEARING THE

TITLE

OF ______________________________________________________

OF THE BUSINESS FIRM NAMED, DO HEREBY REGISTER TO OPERATE SAID BUSINESS WITH THE DOMINANT

BUSINESS ACTIVITY

OF:

_______________________________________________________________________________

In Accordance with the business ordinance, City of Newnan, Georgia, I, the undersigned, certify that I am the person duly authorized by the business herein named to file this return,

including the accompanying schedules and that the information contained in these documents are true, correct and complete. I hereby make application for an Occupational Tax Certificate to

conduct the above-described business in the City of Newnan. I understand that approval must be obtained from the departments having the authority prior to issuance of the certificate. By

signature below, I do solemnly swear, subject to criminal penalties for false swearing, that information contained in the application is true and no false or fraudulent information is made

herein to procure the granting of this certificate.

Owner’s Signature ___________________________________________________________

Date:

_________________________________________

County Tax Assesor's Phone #: 770-254-2680

City Taxes current?

Map or Parcel number of

Property______________________________________

Yes

Landlord or Property Owner’s Name

______________________________________________________________________________________________________________

Complex name (if applicable)