OCCUPATION TAX GENERAL RENEWAL APPLICATION BUSINESS DEVELOPMENT ...

2016

OCCUPATION TAX GENERAL RENEWAL APPLICATION BUSINESS DEVELOPMENT SERVICES

682 Cherry Street Suite 500 Macon, Georgia 31201 Phone (478) 803-0470



Renewal Deadline: April 1st

***IMPORTANT*** Please note that a renewal application form must be completed EACH YEAR even if all information remains the same. The Business License Division cannot process incomplete applications. If any item is missing, incomplete or incorrect, your application cannot be processed. Incomplete renewal applications will be returned.

PLEASE TYPE, OR PRINT BUSINESS NAME:

BUSINESS INFORMATION CHANGE OF BUSINESS NAME: YES NO

PREVIOUS BUSINESS NAME: ***A NEW BUSINESS APPLICATION AND ADDITIONAL INFORMATION IS REQUIRED IF BUSINESS ADDRESS HAS CHANGED***

BUSINESS ADDRESS: (Do Not Use P O Box)

MAILING ADDRESS: (If Different From Business Address)

CITY / STATE / ZIP

CITY / STATE / ZIP

LOCAL BUSINESS PHONE NUMBER:

OWNERSHIP STATUS: Sole Owner Partnership

Corporation Name: CONTACT PERSON FOR BUSINESS:

LLC INC CO

HOME BASED BUSINESS: YES NO

TYPE OF BUSINESS:________________________________________________________

ATTACH COPY OF STATE LICENSE (IF APPLICABLE)

FEDERAL TAX ID #: ___________________________________________

GA SALES TAX ID #: ___________________________________________

CONTACT PERSON AND OWNER'S INFORMATION CONTACT PHONE NUMBER:

EMAIL ADDRESS:

OWNER'S NAME: (First, MI, Last)

OWNER'S HOME ADDRESS:

OWNER'S HOME PHONE NUMBER

CALCULATE YOUR 2016 FEES Please Note: Unpaid Renewal Fees Plus Penalty & Interest For Previous year(s) Must Be Paid Prior To 2016 Fees Being Applied

PROFESSIONAL FEE* (FLAT RATE PER PRACTITIONER)

__________ X 39.00 + 65.00 = $____________

NO. EMPL

RATE

ADMIN FEE

TOTAL AMOUNT DUE

10% Penalty for failure to renew by April 1st & 1.5% Monthly Interest On Delinquent Taxes / Fees

OR

$400 x _______ (Number of = Practitioners) $____________

*Only Professional Practitioners May Elect To Pay A Flat Rate

Of $400 (Per Practitioner) In Lieu Of Paying A Per Employee Rate. Contact The Business License Office To Determine Eligibility.

CERTIFICATION

I (APPLICANT) ____________________________________________________________________________ BEING THE (TITLE) ________________________________________________

(PRINT NAME)

(EX; OWNER/PRESIDENT/MANAGER/CONTACT)

OF THE BUSINESS FIRM NAMED, DO HEREBY REGISTER TO OPERATE SAID BUSINESS WITHIN MACON-BIBB COUNTY.

IN ACCORDANCE WITH THE BUSINESS ORDIANCE OF MACON-BIBB COUNTY, 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 STATEMENTS AND THAT THE SAME ARE TRUE, CORRECT, AND COMPLETE.

DO NOT WRITE IN THIS SPACE. OFFICE USE ONLY

APPLICANTS SIGNATURE_________________________________________________________________ DATE ___________________________

Accepted Methods of Payment: Cash, Debit/Credit, and Check. Make checks payable to "Macon-Bibb County"

License # ____________________

E-VERIFY AFFIDAVIT

Section 1: ONLY COMPLETE IF YOU HAVE 10 OR LESS EMPLOYEES

Private Employer Exemption Affidavit Pursuant to O.C.G.A. ? 36-60-6(d)

By executing this affidavit, the undersigned private employer verifies that it is exempt from compliance with O.C.G.A. ?36-60-6, stating affirmatively that the individual, firm or corporation employs ten (10) or fewer employees and is not required to register with and/or utilize the Federal Work Authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. ? 36-60-6.

I do hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _____________________, _______, 20______ in ___________________ (city), ______ (state)

___________________________________________________

Name of Business

___________________________________________________

Printed Name of Authorized Officer or Agent

___________________________________________________

Signature of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS _________ DAY OF _____________________, 201____.

___________________________ __________________

Notary Public

My Commission Expires

Section 2: ONLY COMPLETE IF YOU HAVE WITH MORE THAN 10 EMPLOYEES

Private Employer Affidavit of Compliance Pursuant To O.C.G.A. ? 36-60-6(d)

By executing this affidavit, the undersigned private employer verifies its compliance with O.C.G.A. ? 36-60-6, stating affirmatively that the individual, firm or corporation employs more than ten (10) employees and has registered with and utilizes the Federal Work Authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. ? 13-10-90. Furthermore, the undersigned private employer hereby attests that its federal work authorization user identification number and date of authorization are as follows:

________________________________________

E-Verify Number

________________________________________

Name of Business

_______________________________

Date of Authorization

I do hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _____________________, _______, 20______ in __________________ (city), _______ (state)

___________________________________________________

Printed Name and Title of Authorized Agent

___________________________________________________

Signature of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS _________ DAY OF _____________________, 201____.

___________________________ __________________

Notary Public

My Commission Expires

***We have in-house Notary service available for Business License documents. If you choose to use the in-house service, these forms must be signed in the presence of the Notary with proper identification***

MACON-BIBB COUNTY, GEORGIA (S.A.V.E.) SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS

O.C.G.A. ? 50-36-1 (e) (2) Affidavit

By executing this affidavit under oath, as an applicant for a Macon-Bibb County, Georgia, Occupation Tax Certificate, Alcohol License, or other public benefit as referenced in O.C.G.A. ? 50-36-1; the undersigned applicant verifies one of the following with respect to my application for a public benefit:

Name of Business:

____________________________________________________________________________

1) __________

2) _________ 3) _________ Homeland

I am a United States citizen. OR

I am a legal permanent resident of the United States. OR

I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Security or other federal immigration agency.

My alien number issued by the Department of Homeland Security or other federal immigration agency is _______________________.

The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. ? 50-36-1 (e) (1), with this affidavit.

The secure and verifiable document provided with this affidavit can best be classified as _____________.

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. ? 16-10-20, and face criminal penalties as allowed by such criminal statute.

Executed in _______________________________________ (City), ___________________________ (State)

_______________________________________

Printed Name of Applicant

______________________________________

Signature of Applicant

SUBSCRIBED AND SWORN BEFORE ME ON

THIS _____DAY OF __________________, 20____

___________________________________________ NOTARY PUBLIC My Commission Expires: ______________________

***We have in-house Notary service available for Business License documents. If you choose to use the in-house service, these forms must be signed in the presence of the Notary with proper identification***

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