Fillable 1. TYPE OF OWNERSHIP: (Check One)

Fill Online, Printable, Fillable, Blank 1. TYPE OF OWNERSHIP: (Check One) Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

1. TYPE OF OWNERSHIP: (Check One)

On average this form takes 18 minutes to complete

The 1. TYPE OF OWNERSHIP: (Check One) form is 3 pages long and contains:

  • 0 signatures
  • 15 check-boxes
  • 64 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
FOR OFFICE USE ONLY
ACCOUNT #
________________
CERTIFICATE #
____________________________
AMOUNT PAID:
$___________________
Gwinnett County Licensing and Revenue
446 West Crogan Street
Lawrenceville, GA 30046
(678) 377-4100
Email Applications to: NewBusinessLicense@gwinnettcounty.com
Completed application and all required affidavits/forms and approvals must be submitted together.
Applications submitted with missing information, documents and/or required approvals will not be accepted.
1. TYPE OF OWNERSHIP: (Check One)
Sole Proprietorship Partnership Corporation Limited Liability Company (LLC)
2. BUSINESS: (Check One) HOME BASED COMMERCIAL BASED
(a) Tradename/DBA Name: __________________________________________________________
(b) Business Location: ______________________________________________________________
Address (including Suite/Unit #) (No P.O. Box or Virtual Office)
______________________________________________________________________________
City State Zip Code Business Phone
(c) Mailing Name: __________________________________________________________________
(d) Mailing Address: ________________________________________________________________
Address (including Suite/Unit #) or P.O. Box
______________________________________________________________________________
City State Zip Code
3. APPLICANT (NAME OF SOLE OWNER / PARTNER / OFFICER OF CORP / MEMBER OF LLC):
(a) Full Name: ____________________________________________________________________
(b) Mailing Address: ________________________________________________________________
Address or P.O. Box
______________________________________________________________________________
City State Zip Code Phone
2
4. LOCAL BUSINESS CONTACT PERSON: (for commercial located businesses only)
(a) Full Name: ____________________________________________________________________
MUST BE A GEORGIA RESIDENT
(b) Home Address: _________________________________________________________________
Address (No P.O. Box or Commercial Address)
______________________________________________________________________________
City State Zip Code Phone
5. LEGAL ENTITY (CORPORATION / LIMITED LIABILITY COMPANY / LIMITED PARTNERSHIP):
(a) Complete Legal Entity Name: ______________________________________________________
(b) Date of Formation with the Georgia Secretary of State (MM-DD-YYYY): _____________________
(c) List All Officers / Members / Partners by Name and Position:
Complete Name Position
1: _________________________________________________ ___________________________
2: _________________________________________________ ___________________________
3: _________________________________________________ ___________________________
Attach sheet if additional space is required
6. PARTNERSHIPS NOT FILED WITH THE SECRETARY OF STATE: Date Formed: ___________
MM-DD-YYYY
(a) List Partners:
1. ______________________________________ ___________________________
Full Name % of Ownership
Home Address: ________________________________________________________________________
Address (No P.O. Box or Virtual Office)
______________________________________________________________________
City State Zip Code Phone
2. _______________________________________ ____________________________
Full Name % of Ownership
Home Address: ________________________________________________________________________
Address (No P.O. Box or Virtual Office)
______________________________________________________________________
City State Zip Code Phone
3
7. FEDERAL TAX ID # _______________________ OR LAST FOUR DIGITS OF THE SS#
FOR THE SOLE OWNER / OFFICER / PARTNER / SOLE MEMBER ____________________
8. DATE BUSINESS WILL OPEN/OPENED AT THIS LOCATION (MM-DD-YYYY): _____________
9. DESCRIBE LINE OF WORK: ______________________________________________________
10. NAICS CODE (6 DIGITS): ______________________ Visit https://www.naics.com/search to
identify code.
11. PROJECTED GROSS REVENUE FROM CUSTOMERS IN GEORGIA: $____________________
12. NUMBER OF EMPLOYEES AT THIS LOCATION (INCLUDE OWNER AS ONE): _____________
13. * GEORGIA SALES AND USE TAX ACCOUNT NUMBER (9 DIGITS): _____________________
14. EMAIL ADDRESS (REQUIRED-ANNUAL RENEWALS ARE ONLINE):
_______________________________________________@_______________.com
I CERTIFY THE ABOVE INFORMATION IS TRUE AND CORRECT AND CONTAINS NO FALSE OR
FRAUDULENT INFORMATION. IN ADDITION, I UNDERSTAND MY BUSINESS LOCATION MUST CONFORM
TO ALL GWINNETT COUNTY ORDINANCES, RULES AND REGULATIONS. FURTHERMORE, I UNDERSTAND
NON-COMPLIANCE WITH ANY GWINNETT COUNTY ORDINANCE, RULE OR REGULATION WILL RESULT IN
NON-RENEWAL OF THE BUSINESS / OCCUPATION CERTIFICATE FOR THIS BUSINESS.
Printed Name: ___________________________________ Title: ______________________________
Sole Owner/President/CEO/Managing Member/Majority Partner
Signature: _______________________________________________ Date: _____________________
Sole Owner/President/CEO/Managing Member/Majority Partner
Check List for Attachments (Provide Copies)
(All businesses) If this business is a LLC, Corporation or Limited Partnership, provide a copy of the GA
Secretary of State Certificate of Organization / Incorporation and Articles listing all officers and agents
(All businesses) If your profession / occupation is required to obtain a state license, health permit, or
any other regulatory approval from any state, federal or professional licensing board, provide a copy of
the current license / certification
(All businesses) Original notarized E-Verify Private Employer of Compliance Affidavit
(All businesses) Original notarized U.S. Citizen / Qualified Alien Affidavit along with a front and back
copy of your secure and verifiable identification document
(Commercial based businesses) Certificate of Occupancy reflecting your DBA/Tradename
(Home based businesses) State of GA issued Driver’s License/Photo ID showing current home
address, which must match location address on Page 1
* Contact the Georgia Department of Revenue (Georgia Tax Center) to determine if required for this business type
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

1. TYPE OF OWNERSHIP: (Check One)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 March 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document