City of Fayetteville Occupational Tax Permit (Business License) HOME Application.
BUSINESS NAME AND LOCATION: Local street address in Fayetteville.
DESCRIPTION OF BUSINESS: Please list ALL business activities to be conducted by this business. This is the
description that will be printed on the permit. (Example: Janitorial Services, Internet Sales, etc.)
PLEASE PROVIDE COPY OF STATE LICENSE IF APPLICABLE
GROSS REVENUE INFORMATION: Please estimate gross revenue from the time the business opens through
the end of the calendar year. The definition of gross receipts is attached to the back of the application.
Number of full-time and part-time employees for the company (include employees of all locations). If more than
ten (10) employees, E-Verify number is required. Please note that a State or Federal Tax ID is not the same as an
E-Verify number.
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.
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 home or apartment.
PLEASE NOTE: If you are renting a home or apartment, you must provide a letter from the property owner or
management stating you have permission to use the rental property address for your business license.
STATEMENT OF INTENT: Please answer questions 1 through 7. PLEASE NOTE: Statement of Intent must
be signed in front of a notary. Notaries are available at City Hall.
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 BE
SURE TO SIGN IN FRONT OF THE NOTARY.
NOTE: Home Occupation permits must be approved by Planning & Zoning. If no one is available to approve the
application, you will be contacted when the license is ready to pick up. Payment must be made at the time the
license is picked up.
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. 12/26/19
HOME 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: ________________________
ESTIMATED GROSS REVENUE FROM START DATE THROUGH 12/31/20:________________________
ALL REVENUE INFORMATION CONFIDENTIAL (GEORGIA LAW)
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: A non-pro-rated, non-refundable administrative fee of $75 shall be required on all business occupational
tax accounts for the initial start-up, renewal or re-opening of accounts. The administrative fee shall be due and
payable at the time of registration pursuant to Section 46-83. The administrative fee shall be credited against any
occupational tax due for the year of registration. (Sec. 46-79 City of Fayetteville Ordinance)
STATEMENT OF INTENT
TO OPERATE A CUSTOMARY HOME OCCUPATION
Business Name:
Address:
Date:
Home Phone:
Business Phone (If Different)
E-MAIL:
Please provide the following information along with the application for a customary home occupation (and all
other relevant materials, fees, and information) to the City of Fayetteville Business License Department. If
needed, additional pages may be attached to this affidavit.
1. If the home occupation is to be operated out of an apartment, please attach a letter of approval from
the owner or manager of the apartment.
Letter Attached: Yes__________ No__________ Not Applicable___________
2. If the home occupation is to be operated from rental property other than an apartment, please
attach letter of approval from the property owner.
Letter Attached: Yes__________ No__________ Not Applicable___________
3. Will there be any other person working at this location? If so, how many?
Yes__________ No__________
Number of Non-Resident Employees ___________________
4. Will there be any storage of business related items or materials? If so, where will the items or
materials be stored?
Yes __________ No__________
Storage
location:_______________________________________________________________________
______________________________________________________________________________
5. Will there be any signage or advertisements of any kind at the home? If so, where will this signage
or advertisement be located on site?
Yes __________ No__________
Location of signage or advertisements:______________________________________________
_____________________________________________________________________________
6. Will there be retail sales of any kind at the residence? If so, how and where will the sales be
transacted?
Yes __________ No__________
Retail sales transacted____________________________________________________________
______________________________________________________________________________
7. Please provide a detailed description of the nature of the business to be conducted at the site.
Attach additional sheets if necessary.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
STATEMENT OF INTENT
Applicant’s Signature:______________________________________________________
Date:____________________________________
Notary Public:_____________________________________________________________
Seal of Notary Public
This Statement of Intent to operate a customary home occupation has been received and reviewed by the
Planning and Zoning Department, and has been DENIED/APPROVED for the following reasons, and with the
following conditions and comments:
Reasons:
Conditions/Comments:
Signature:
Date:
NEW OCCUPATIONAL TAX INFORMATION
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
OFFICIAL ADDENDUM TO BUSINESS OCCUPANCY LICENSE APPLICATION
Required Fields
Name of Resident (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)
EMPLOYEES OR LESS.
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 __________, ________ 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:
_______________________________________
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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