Occupation Tax Return - The City Of Newnan Page 4

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City of Newnan, Georgia
New Occupational Tax Certificate Application – Contacts Listing
Corporation/Limited Liability Company (if applicable)
Corporation/LLC Name
____________________________________________________________________________________________________
Address
________________________________________________________________________________________________________________
Phone
________________________________
President/CEO
____________________________________________________________________
President’s Home Address &
Phone__________________________________________________________________________________________
President’s Email
__________________________________
Date of Incorporation/LLC
_______________
State of Incorporation/LLC
____________
Partnership (if applicable)
Partner’s Name & Address
_____________________________________________________________________________________________
Partner’s Home Phone/Cell
______________________________________________
Email
_________________________________________
Partner’s Name & Address
_____________________________________________________________________________________________
Partner’s Home Phone/Cell
______________________________________________
Email
_________________________________________
Additional Owners or Contacts:
Name:
_________________________________
Title:
___________________________
Home Phone:
____________________________________
Home Address:
___________________________________________________________
Email:
_________________________________________
Name:
_________________________________
Title:
___________________________
Home Phone:
____________________________________
Home Address:
___________________________________________________________
Email:
_________________________________________
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C i t y o f N e w n a n , 2 5 L a G r a n g e S t r e e t , N e w n a n , G A 3 0 2 6 3

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