R110 (1/10/10)
City of Johns Creek
Revenue
11360 Lakefield Drive
Johns Creek, Georgia
30097 (678) 512-3242
www.johnscreekga.gov
Business Occupation Tax Reconciliation
♦ Move Out of City, Close or Sale of Existing Business ♦
Business Name & Contact Information
Location Address with Suite/Unit
SIGNATURE TITLE DATE
I hereby certify, under penalty of perjury, that statements made herein are to the best of my knowledge true & correct.
TAX RECONCILIATION FOR CLOSING YEAR ACTUALS
Calculation to Determine Taxable Gross Receipts
(a) Estimate (From
Closing Year Return)
(b) Actual (At Date of
Close)
(2) Allowable deductions included in item (1)
A. Sales, use or excise taxes
B. Sales returns and allowances
C. Inter-organizational sales
D. Payments to subcontractors or independent agents
(Attach name, address, phone # & amount paid)
E. Governmental and foundation grants or charitable contributions
H. Total allowable deductions - total of (2)A through (2)G
(3) Taxable gross receipts – line (1) minus line (2)H (enter 0 if amount is negative)
Occupation Tax Adjustment
(4) Actual taxable gross receipts for the closing year – enter line 3(b)
(5) Prior year estimated taxable receipts – enter line 3(a)
(6) Receipts adjustment – line (4) minus line (5) (+ or -)
(7) Tax adjustment – multiply line (6) by the tax rate (+ or -)
(8) Actual # of employees for the closing year
(9) Prior year estimated # of employees (reported on current year occupation tax return)
(10) Number of employees for adjustment – line (8) minus line (9) (+ or -)
(11) Employee adjustment – multiply line (10) by $13 per employee (+ or -)
(12) Total Occupation Tax Adjustment / Reconciliation for Current Year - line 7 plus line 11 (+ or -)
** Attach the Following Documentation:
(1) Proof of Actual Gross Receipts Prior to Sale, Close or Move (example: Closing Income Tax Statement);
(2) Proof of Move, Close or Sale;
(3) Current Occupation Tax and Any Current Licenses issued by the City of Johns Creek ; and
(4) Payment for Any Amount Due (make checks payable to the City of Johns Creek)
STAFF USE: REVENUE: Initials: Amount Due: Amount Paid:
Balance Due: Receipt #:
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