Fillable City of Fayetteville Occupational Tax Permit (Business License) (City of Fayetteville)

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City of Fayetteville Occupational Tax Permit (Business License) (City of Fayetteville)

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City of Fayetteville Occupational Tax Permit (Business License) PROFESSIONAL
Application Instructions.
BUSINESS NAME AND LOCATION: Local street address in Fayetteville.
DESCRIPTION OF BUSINESS: Please list ALL business activities to be conducted at this location. This is
the description that will be printed on the permit. (Example: Medical Practice, Surgery Center, Legal Practice)
Please provide copy of state license for all professionals.
Number of full-time and part-time employees of the company (Fayetteville location).
Social Security number, Federal or State Tax ID, and/or Sales Tax number: At least one is required.
BUSINESS OWNER: Name of the Corporation, LLC, Partnership, individual, etc., that owns the business.
PLEASE PROVIDE COPY OF ARTICLES OF INCORPORATION
Mailing address, phone number, and e-mail address of business owner.
Name and title of person completing the application (owner, manager, etc.)
U.S. Citizen: Please check yes or no. If not a citizen, please bring in legal resident card.
NAME AND ADDRESS OF PROPERTY OWNER: Company or person that owns the building.
Emergency Contact Form: Please complete all emergency contact information as listed.
New Occupational Tax Sheet: Please complete all information.
Department of Revenue Official Addendum to Business Occupancy License Application:
Please complete this form even if you do not have a sales tax number.
The Private Employer Affidavit and the U.S. Citizen/Qualified Alien Affidavit must be signed and
notarized. Notaries are available at City Hall, or you may use a notary elsewhere. Please bring your driver’s
license or photo I.D. with you. If you are not a U.S. citizen, please bring your green card or proof of legal
residence. PLEASE SIGN IN FRONT OF THE NOTARY. Please list the number of full-time and part-time
employees (all locations combined) on the Private Employer Affidavit. If more than ten employees, an E-
Verify number is required. NOTE: This is not the same as a State or Federal Tax ID number.
When your application is received, it will be e-mailed to the departments listed for their approval. You will be
contacted when the license is ready to pick up.
Professionals will not pay a fee upon initial application. Each year at the time of renewal, professionals
may choose to either pay a $300 flat fee per professional, or a tax based on gross revenue (kept
confidential), which will not be less than $75.
Please note all occupational tax permits expire on December 31
st
. Renewal forms will be mailed in December
2020. Please complete and return the forms, and you will be billed for 2021. Payment for the 2021 renewal
must be received by March 31, 2021 to avoid penalty and interest. Please keep us updated if your mailing
address changes, or if you move from one location to another, or close the business.
If you have any questions, please call 770-719-4165 or e-mail PBrown@fayetteville-ga.gov. Rev. 04/17/20
PROFESSIONAL CITY OF FAYETTEVILLE
240 GLYNN STREET SOUTH
FAYETTEVILLE, GA. 30214
Phone: 770-461-6029 FAX: 770-460-4238
OCCUPATIONAL TAX PERMIT (BUSINESS LICENSE) APPLICATION
( ) LLC ( ) Home Occupation RENEWAL DUE: 01-01-2021
( ) Single Proprietor ( ) Non-Profit Organization PENALTY APPLIED: 04-01-2021
( ) Corporation/Partnership CITATIONS ISSUED: 05-01-2021
BUSINESS NAME:_________________________________________________________________________
BUSINESS LOCATION:____________________________________________________________________
(Please include suite number if applicable.) (Fayetteville GA)
DESCRIPTION OF BUSINESS:______________________________________________________________
(List all business activities to be conducted at this location)
BUSINESS LOCAL PHONE: ________________________
NUMBER OF EMPLOYEES: _____Full-Time _____Part-Time E-VERIFY #________________________
(If more than 10 employees)
SOCIAL SECURITY #:___________________ FEDERAL TAX ID:_____________________
STATE TAX ID:_________________________SALES TAX #:_________________________
BUSINESS OWNER INFORMATION:
BUSINESS OWNER:_______________________________________________________________________
(Name of Corporation, LLC, Individual, etc.)
MAILING ADDRESS: ______________________________________________________________________
PHONE:_______________________ E-MAIL:__________________________________________________
APPLICATION COMPLETED BY:____________________________________________________________
IS APPLICANT U.S. CITIZEN? _____YES _____NO (If no, please bring in legal resident card.)
PROPERTY OWNER’S INFORMATION:
NAME:___________________________________________________________________________________
ADDRESS: _______________________________________________________________________________
NOTE: Professionals do not pay a upon initial application. Each year at the time of renewal, professionals
may choose to either pay the flat rate of $300 per professional, or a tax based on gross revenue, which will not
be less than $75 (administrative fee).
●
●
FAYETTE COUNTY E-9-1-1 COMMUNICATIONS
EMERGENCY CONTACT FORM
Name of Business: _________________________________________________________________________
Business Address: __________________________________________________________________________
_________________________________________________________________________________________
Prior Business Name (if applicable) ___________________________________________________________
Prior Address of Business in Fayette County (if applicable):_________________________________________
_______________________________________________________________________________________
Business Phone Number ___________________________________________________________________
Business Owner(s) Name: __________________________________________________________________
Business Owner(s) Home Phone Number: ______________________________________________________
(Emergency use only)
Building Owner Name:_______________________________________________________________________
Building Owner Phone Number: ___________________________________________________________
Additional Emergency Contact: (Someone who can gain access to the business after normal business hours in
the event of Fire, Burglar Alarm, or Other Emergency)
1) Name ______________________________ Phone #_________________________________
2) Name ______________________________ Phone #_________________________________
3) Name ______________________________ Phone #_________________________________
NEW OCCUPATIONAL TAX
New Business ( )
New Business Owner ( )
New Location ( )
Name Change ( )
Home Occupation ( )
Business Located in Main Street District: ____Yes ____No
If so, how many employees? ______
E-Mail Address: ____________________________________
DATE: ________________________
PHONE: _______________________
___________________________________________ ________________________________________
BUSINESS NAME BUSINESS ADDRESS
___________________________________________ ________________________________________
CONTACT PERSON TYPE OF BUSINESS
FOR STATISTICAL PURPOSES ONLY: Please select the following SBA Class which best describes your
(OPTIONAL) business: _____ Small Business _____ Female ______ Minority
●
✔
✔
✔
IMPORTANT INFORMATION FOR
NEW BUSINESS APPLICANTS
Renovations – Most modifications to a building will require a permit from the City’s Building
Department. If you are planning to alter the interior or exterior of your new business in any way
(add walls, remove walls, electrical/plumbing/heating and air work, etc.) please contact Kim
Craig prior to starting your project: (770) 719-4065 / kcraig@fayetteville-ga.gov
Exterior Renovations to a building require approval from the Planning and Zoning
Commission. Please contact Julie Brown at (770) 719-4180 / jbrown@fayetteville-ga.gov
Signage – A permit from the City of Fayetteville is required for new sign installations and in
most cases existing sign modifications. Prior to moving forward with any signage for your new
business, please contact Geneva Walker regarding the City’s requirements and ordinances
pertaining to signs: (770) 719-4177 / gwalker@fayetteville-ga.gov
Water Department - If your business is located inside the City Limits of Fayetteville and you
are the responsible party for paying for water and/or sewer service, you will need to bring with
you a copy of your lease, two forms of ID, and there is a processing fee or transfer fee. Please
contact Brenda Williams at (770)719-4187 / bwilliams@fayetteville-ga.gov for more
information.
Modify or Add Business Activities – If at any time you plan to modify or add to the type of
business activities associated with your license beyond the original description, you are required
to contact the city in advance and apply to have the new or modified activities approved. Please
contact Phyllis Brown at 770-719-4165 / pbrown@fayetteville-ga.gov
__________________________________________ ________________
SIGNATURE OF APPLICANT DATE
ADDITIONAL REQUIREMENTS FOR PLACES OF ASSEMBLY
To ensure the citizens and visitors of the City of Fayetteville are provided with safe structures, the following
information is required for all businesses classified as an assembly occupancy (including but not limited to:
restaurants, dance halls, gyms, places of religious worship, etc.). This information shall be professionally
prepared and drawn to scale with sufficient clarity and shall contain at minimum:
Business name
Site address
A key plan is required if the business is in a multi-tenant building. (A key plan is a small, overall layout
of the building that identifies the area in question – see example below)
Existing and proposed floor plan
Full dimensioned plan (with room dimensions and square footages) of proposed layout
All rooms to be labeled for their intended use
Details of restrooms (number and location of ADA compliant restrooms, total number of toilet and sinks
provided in each restroom, etc.)
Life safety plan (complete with path of egress, emergency lighting, occupancy loads, etc.)
If there are no proposed changes to the mechanical, electrical or plumbing (MEP) systems then that will
need to be noted on the plans. If there are proposed changes then full MEP drawings reflecting the
proposed changes will be required.
For questions regarding the plan requirements, please contact:
Kim Craig Bill Rieck
Building Official OR Fire Marshall
(770) 719-4065 (770) 719-4052
kcraig@fayetteville-ga.gov brieck@fayetteville-ga.gov
OFFICIAL ADDENDUM TO BUSINESS OCCUPANCY LICENSE APPLICATION
Required Fields
Name of Business (Legal Name or Trade Name)
Mailing Address if Different From the Physical Address
Actual Physical Address of Each Location of Such Business if Different From the Mailing Address
Sales Tax ID #, if your Business is Required to Have One by Law:
Applicable North American Industry Classification System Code Number (Please list all NAICS):
NOTICE
Upon completion or refusal to complete this form by the taxpayer, the municipality or county shall provide written
notice to the taxpayer that the above information will be submitted to the Georgia Department of Revenue.
The failure or refusal to complete this form by the taxpayer shall not toll or extend the time of payment established for
such occupation tax or regulatory fee under Code Section 48-13-20.
In accordance with O.C.G.A. 48-2-15 and 48-7-60, all taxpayer information provided on this Form shall be confidential
and privileged.
In compliance with O.C.G.A. 48-1-2 and 48-8-33, the Commissioner of the Georgia Department of Revenue shall collect
all sales tax remitted in Georgia.
Any questions or comments regarding the collection of sales tax or this Form should be directed to the Georgia
Department of Revenue at (404) 417-6605 or sent to Tax Law & Policy, 1800 Century Blvd., NE, Atlanta, GA. 30345
An Equal Opportunity Employer
Private Employer Affidavit Pursuant to O.C.G.A. § 36-60-6(d)
Required by Georgia Law
By executing this affidavit under oath, as an applicant for a(n) _______________________________ [business license,
occupational tax certificate, or other document required to operate a business] as referenced in O.C.G.A. § 36-60-6(d),
from the City of Fayetteville, Georgia, the undersigned applicant representing the private employer known as
________________________________________________________ [printed name of business]
verifies one of the following with respect to my application for the above mentioned document:
(CHECK ONE)
_______ On January 1st of the below signed year the individual, firm, or corporation employed MORE THAN
TEN (10) EMPLOYEES.
_______ On January 1st of the below signed year the individual, firm, or corporation employed TEN (10) OR
LESS EMPLOYEES.
IF THE EMPLOYER SELECTED MORE THAN TEN (10) EMPLOYEES, PLEASE FILL OUT
FEDERAL WORK AUTHORIZATION USER ID NUMBER BELOW. THIS IS NOT THE
SAME AS THE TAX ID NUMBER.
The employer has registered with and utilizes the federal work authorization program in accordance with the applicable
provisions and deadlines established in O.C.G.A. § 36-60-6(a). The undersigned private employer also attests that its
federal work authorization user identification number and date of authorization are as listed below:
_____________________________________________
Federal Work Authorization User Identification Number
_____________________________________________
Date of Authorization
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 allowed by such statute.
Executed on the ______ day of ___________, 202___ in _______________________(City)_________(State)
___________________________________________________________
Signature of Authorized Officer or Agent (Representative of Business)
___________________________________________________________
Printed Name of and Title of Authorized Officer or Agent (of Business)
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE ______ DAY OF ____________________, 202____.
_________________________________________________
NOTARY PUBLIC
My Commission Expires:
___________________________
●
U. S. CITIZEN/QUALIFIED ALIEN AFFIDAVIT
By executing this affidavit under oath, as an applicant for a City of Fayetteville, Georgia Business License or
Occupational Tax Certificate, Alcohol License, or other public benefit as referenced in O.C.G.A. Section 50-36-
1, I am stating the following with respect to my application for a City of Fayetteville Business License or
Georgia Occupational Tax Certificate, Alcohol License, Taxi Permit or other public benefit (CIRCLE ONE)
for:
______________________________________________
(Name of natural person applying on behalf of individual,
business, corporation, partnership, or other private entity)
1) ______ I am a United States Citizen
OR (only check one)
2) ______ I am a legal permanent resident 18 years of age or older, or I am an otherwise qualified alien or
non-immigrant under the Federal Immigration and Nationality Act, 18 years of age or older and lawfully
present in the United States.*
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
Code Section 16-10-20 of the Official Code of Georgia.
Signature of Applicant: Date:
__________________________________ __________
Printed Name:
___________________________________
SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE *___________________________________
____ DAY OF __________, 20__ Alien Registration Number for Non-Citizens
_____________________________
Notary Public
My Commission Expires:_________
*Note: O.C.G.A. 50-36-1(e)(2) requires that aliens under the Federal Immigration and Nationality Act, Title 8 U.S.C., as amended,
provide their alien registration number. Because legal permanent residents are included in the Federal definition of “alien”, legal
permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number
may supply another identifying number below:
___________________________________________
●
OCCUPATIONAL TAX CERTIFICATE
DEPARTMENTAL APPROVALS
Prior to the issuance of an occupational tax certificate, application must be approved by each of the following
departments.
Zoning Department 770-719-4180
Julie Brown
Water Department 770-719-4161
Carleetha Talmadge
Fire Department
Bill Rieck 770-719-4052
Building Department 770-719-4065
Kim Craig or Designee
Fayette County Health Dept. 770-305-5415
(Restaurants and Food Service)
Copy of state license required, if applicable, before city license is released.
Copy of Health Department certificate required, if applicable, before city license is released.
IF YOUR BUSINESS MOVES FROM ONE LOCATION IN THE CITY OF FAYETTEVILLE TO
ANOTHER, YOU MUST COMPLETE A NEW OCCUPATIONAL TAX (BUSINESS LICENSE)
APPLICATION, COMPLETE WITH DEPARTMENTAL APPROVALS, TO ENSURE THAT YOUR NEW
LOCATION MEETS THE REQUIREMENTS OF CITY ORDINANCES, AND TO PROVIDE CURRENT
EMERGENCY CONTACT INFORMATION FOR THE FAYETTE COUNTY E-911 COMMUNICATIONS
CENTER.
IF YOUR BUSINESS IS CLOSED, OR MOVES OUT OF THE CITY LIMITS OF FAYETTEVILLE,
PLEASE NOTIFY THE OCCUPATIONAL TAX OFFICE (770-719-4165) IN ORDER THAT WE MAY
CLOSE YOUR ACCOUNT WITH THE CITY.
THIS LICENSE DOES NOT TRANSFER FROM ONE OWNER TO ANOTHER. THE NEW BUSINESS
OWNER IS REQUIRED TO COMPLETE AND SUBMIT AN APPLICATION TO CITY HALL
Revised 04/17/2020
DEFINITION OF GROSS RECEIPTS
Sec. 46-66(1)
Gross receipts means the total revenue of the business or practitioner for the
period, including without being limited to, the following:
a.
Total income without deduction for the cost of goods sold or expenses
incurred;
b.
Gain from trading in stocks, bonds, capital assets or instruments of
indebtedness;
c.
Proceeds from commissions on the sale of property, goods or services;
d.
Proceeds from fees for services rendered; and
e.
Proceeds from rent, interest, royalty or dividend income.
(2)
Gross receipts shall not include the following:
a.
Sales, use or excise tax;
b.
Sales returns, allowances and discounts;
c.
Interorganizational sales or transfers between or among the units of a
parent-subsidiary controlled group of corporations as defined by 26 USC
1563(a)(1), or between or among the units of a brother-sister controlled
group of corporations as defined by 26 USC 1563(a)(2), or between or
among wholly owned partnerships or other wholly owned entities;
d.
Payments made to a subcontractor or an independent agent;
e.
Governmental and foundation grants, charitable contributions, or the
interest income derived from such funds, received by a nonprofit
organization which employs salaried practitioners otherwise covered by
this article, if such funds constitute 80 percent or more of the
organization's receipts; and
f.
Proceeds from sales to customers outside the state.
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City of Fayetteville Occupational Tax Permit (Business License) (City of Fayetteville)

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Completed 3 August 2020

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