CITY OF
DAHLONEGA
465 Riley
Road
Dahlonega, Georgia
30533
Phone: 706-482-2725 • Fax:
706-864-4837
AFFIDAVIT RETAIL PACKAGE
Food / Alcohol Sales / Merchandise
On or before the 15th day of November of each year, each applicant for a retail license for Package sales renewal shall
furnish to the City Clerk for the months of August, September and October of the then current calendar year an affidavit
showing the gross sale of groceries and food products, excluding sale of Malt Beverages and Wines; the gross sales of Malt
Beverages and Wines; and the gross sale of other merchandise. This affidavit shall be on a form furnished by said Clerk, and
attached to this affidavit shall be a copy of the Georgia Sales and Use report for the three monthly periods. Package store
Class B and C licenses shall be revoked if gross sales of groceries and food products excluding sale of Malt Beverages and
Wines fall below the sum of one thousand five hundred dollars ($1,500.00) monthly for three consecutive months.
GROSS SALES REPORT FOR THREE CONSECUTIVE MONTHS
TO INCLUDE AUGUST, SEPTEMBER AND OCTOBER
NAME OF ESTABLISHMENT:
Groceries and Food
Products (excluding Malt
Beverages and Wines) Malt Beverages and Wines Other Merchandise
August:
September:
October:
TotalGrossSales:
Attached to this affidavit is a copy of the Georgia Sales and Use report for the three monthly periods which is sworn to be true
and correct.
Signature of Affiant
Printed Name of Affiant
Sworn to and subscribed before me this day of ,20 .
Notary Public
State of Georgia (Affix Seal Here)
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