Fillable DEKALB COUNTY BUSINESS REGISTRATION APPLICATION (DeKalb County Government)

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DEKALB COUNTY BUSINESS REGISTRATION APPLICATION (DeKalb County Government)

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DEPARTMENT OF PLANNING & SUSTAINABILITY
330 W. PONCE DE LEON AVE. DECATUR GA 30030 (404) 371-2461 FAX (404) 371-2946
Page 1 of 2
BL Form 105 v.17.3 Effective 6.23.2020
DEKALB COUNTY BUSINESS REGISTRATION APPLICATION
BUSINESS INFORMATION
☐ SOLE PROPRIETOR ☐ LIMITED LIABILITY COMPANY (LLC) ☐ PARTNERSHIP
☐ FOR PROFIT
☐ CORPORATION ☐ TRUST ☐ OTHER ______________________________________
☐ NON-PROFIT
FED EMPLOYER ID #
____________________________
GA SALES AND USE TAX #
_________________________________
FED WORK AUTHORIZATION #
_______________________________________
PERMIT/ C.O.#
______________________
LOCATION TYPE
SANITATION PROVIDER NAME
☐
HOME BASED
☐
COMMERCIAL
_____________________________________________
LEGAL/ ENTITY NAME:
TRADE NAME/ DBA NAME:
________________________________________________________________
__________________________________________________________________________
PRIMARY LINE OF BUSINESS TO BE CONDUCTED:
______________________________________________________________________________________________________________________________________________
OTHER LINE OF BUSINESS TO BE CONDUCTED:
______________________________________________________________________________________________________________________________________________
PHONE: ______________________________________________________
EMAIL: _________________________________________________________________
PHYSICAL (LOCATION) ADDRESS (Street, City, State, Zip) P. O. BOX NOT PERMITTED
________________________________________________________________ ____________________________________________
GA
__________________
BILL TO/MAILING ADDRESS (Street City, State, Zip) (If different) P. O. BOX PERMITTED
________________________________________________________________ ____________________________________________ _____
__________________
APPLICANT’S INFORMATION
☐
APPLICANT (INDIVIDUAL)
FIRST NAME: ___________________________________________
LAST NAME: ___________________________________________
☐
APPLICANT (BUSINESS ENTITY)
LEGAL NAME: _____________________________________________________
TRADE NAME: ____________________________________________________
DRIVER’S LICENSE #: ____________________________________
STATE OR JURISDICTION REGISTERED: __________________________
PHONE: ____________________________________________________
EMAIL: ________________________________________________________________
ADDRESS (Street) ( City) ( State) ( Zip)
____________________________________________________________
_______________________________________________________________
_____
__________________________
TITLE/ POSITION: _________________________________________ AUTHORIZED AGENT
☐ YES ☐ NO
if NO, Provide description of relationship to business: ______________________________________________________________
OWNERSHIP INFORMATION
(List EACH owner with 10% or more ownership interest. SKIP if applicant is sole owner with 100% ownership interest.)
☐ OWNER 1 (INDIVIDUAL)
☐ OWNER 1 (BUSINESS ENTITY)
FIRST NAME: __________________________________________
LAST NAME: __________________________________________
LEGAL NAME: _____________________________________________________
TRADE NAME: _____________________________________________________
DRIVER’S LICENSE #: _____________________________________
STATE OR JURISDICTION REGISTERED: __________________________
PHONE: _____________________________________________________
EMAIL: ________________________________________________________________
ADDRESS (Street) ( City) ( State) ( Zip)
____________________________________________________________________________________________
____________________________________________
_____
__________________
TITLE/ POSITION: ________________________________________
OWNERSHIP INTEREST PERCENTAGE (%) ____________________
☐ OWNER 2
(INDIVIDUAL)
FIRST NAME: __________________________________________
LAST NAME: __
________________________________________
☐ OWNER 2 (BUSINESS ENTITY)
LEGAL NAME: ____________________________________________________
TRADE NAME: ____________________________________________________
DRIVER’S LICENSE #: ___________________________________
STATE OR JURISDICTION REGISTERED: __________________________
PHONE: ___________________________________________________
EMAIL: ________________________________________________________________
ADDRESS (Street) ( City) ( State) ( Zip)
_________________________________________________________________________________
____________________________________________
_____
__________________
TITLE/ POSITION: __________________________________________
OWNERSHIP INTEREST PERCENTAGE (%) _____________________
(Attach Additional Sheet(s) As Needed)
TOTAL NUMBER OF OWNERS: ________________________
TOTAL OWNERSHIP INTEREST PERCENTAGE: 100%
DEPARTMENT OF PLANNING & SUSTAINABILITY
330 W. PONCE DE LEON AVE. DECATUR GA 30030 (404) 371-2461 FAX (404) 371-2946
Page 2 of 2
BL Form 105 v.17.3 Effective 6.23.2020
BUSINESS OCCUPATION TAX
1. GEORGIA GROSS RECEIPTS (Current Year Estimate)
$
2. EXEMPTION
$20,000.00
3. TAXABLE GROSS RECEIPTS
(Subtract line 2 from line 1, if negative enter $0.00)
$
4. GROSS RECEIPT TAX (Max. $50,000.00)
(Multiply line 3 by rate)
NACIS: _________________
Rate:
_________________
$
5. ☐ EMPLOYEE FEE ☐ PROFESSIONALS ELECTION *
(At least one, include owner/operator)
(Multiply # of Employees or Practitioners by Rate)
Required E-Verify # if 10 or More Employees ___________________
Number of Employees or
Practitioners
______________________
Rate ______________________
$
6. ADMINISTRATIVE FEE $75.00 (Nonrefundable/ Nontransferable)
$
7. FLAT TAX FEE $50.00
$
8. TOTAL TAX DUE
(Enter Sum Lines 4, 5, 6 & 7)
$
APPLICANT’S ACCEPTANCE AND ACKNOWLEDGEMENT
(mm/dd/yyyy)
______
____________________________________________ _______________________________________________ _______________________
PRINT APPLICANT’S NAME APPLICANT’S SIGNATURE DATE
ZONING DIVISION OFFICE USE ONLY
SAP/ SLUP
APPROVAL
DESCRIPTION OF USE:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Code Se
ction: __________________________________
☐ YES
☐
NO
☐
NOT APPLICABLE
OVERLAY DISTRICTS
AND/ OR ZONING
CONDITIONS
DESCRIPTION/ COMMENTS:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_________________________________________ ____________________________________________ ______________ __
☐ YES
☐
NO
☐ NOT APPLICABLE
LOE APPROVAL
☐
YES
☐
NO
☐
NOT APPLICABLE
DESCRIPTION/ COMMENTS:
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
______
_________________________________________________________________________________________________________
(mm/dd/yyyy)
_______
___________________________________________ _______________________________________________ _______________________
PRINT REVIEWER’S NAME REVIEWER’S SIGNATURE DATE
*Professionals Election O.C.G.A 48-13-9 (C)(2). Flat Fee of $400.00/ Professional Practitioner.
BL Form 104 v.17.3 Effective 6.23.2020
330 W. Ponce de Leon Ave
Decatur, GA 30030
www.dekalbcountyga.gov/planning
Office: 404-371-2155
Chief Executive Officer
Michael Thurmond
DEPARTMENT OF PLANNING & SUSTAINABILITY
Director
Andrew A. Baker, AICP
BUSINESS REGISTRATION AFFIDAVIT
ALL STATEMENTS MUST BE INITIALED AND MUST BE EXECUTED UNDER OATH (NOTARIZED).
TO BE COMPLETED BY APPLICANT
________________
I do solemnly swear that the information on this application is true, and that no false or
misleading statement is made herein to obtain a business occupation tax certificate.
________________
I understand that if I provide false or misleading information in this application, I may be
subject to criminal prosecution and/or immediate revocation of my business occupation tax
certificate issued as a result of this application.
________________
I understand that I must comply with all county ordinances and regulations.
________________
I hereby agree to provide clearance(s) and/or inspection report(s) required prior to issuance
of a business occupation tax certificate.
________________
I hereby acknowledge receipt of the DeKalb County Smoke-Free Air Ordinance
pursuant to Code Sec. 16-108(c). Click link for PDF download, or Check Box
to request hard copy, or Scan QR Code for web link
TO BE COMPLETED BY BUSINESS PREMISES OWNER
________________
I, the owner of the property, swear to maintain the business premises in accordance with all
applicable property maintenance regulations under this Code as it currently exists or is
hereafter amended, including but not limited to sign, debris, and vegetation regulations
pursuant to DeKalb County Ordinance Code. Sec. 15-28(5)(g).
APPLICANT’S AUTHORIZATION
SUBSCRIBED AND SWORN BEFORE ME ON
THIS THE _________DAY OF____________________
20_________.
__________________________________________________
NOTARY PUBLIC
My Co
mmission Expires: _____________________
I hereby declare under penalty of perjury that the foregoing is
true and correct. Executed on
_________________________, ________________, 20_______
In ______________________________ (City)__________(State)
________________________________________________________
Printed Name and Title of Applicant
_________________________________________________________
Signature of Applicant
BUSINESS PREMISES OWNER’S AUTHORIZATION IF DIFFERENT FROM APPLICANT
SUBSCRIBED AND SWORN BEFORE ME ON
THIS THE _________DAY OF____________________
20_________.
__________________________________________________
NOTARY PUBLIC
My Commission Expires: _____________________
I hereby declare under penalty of perjury that the foregoing is
true and correct. Executed on
_________________________, ________________, 20_______
In ______________________________ (City)__________(State)
________________________________________________________
Printed Owner’s Name
_________________________________________________________
Signature of Owner
CLICK FOR PDF
DOWNLOAD
☐
REQUEST HARD COPY
SCAN FOR
WEB LINK
DEPARTMENT OF PLANNING
& SUSTAINABILITY
Page 1 of 2
404.371.2155 (o)
404.371.4556 (f)
DeKalbCountyGa.gov
Clark Harrison Building
330 W. Ponce de Leon Ave
Decatur, GA 30030
HOME OCCUPATION SUPPLEMENTAL REGISTRATION FORM
BUSINESS INFORMATION
Description of Business
Home Office For: ___________________________________________________________________________________________________
Other: _______________________________________________________________________________________________________________
Address (Street, City, State, Zip)
APPLICANT INFORMATION
First Name:
Last Name:
Phone Number:
Email:
Address If Different (Street, City, State, Zip)
APPLICANT’S ACCEPTANCE AND ACKNOWLEDGEMENT OF SEC. 27-4.2.31
A. A home occupation where no customer contact occurs shall be considered a Type I home occupation
and may be conducted with administrative approval by the director of planning.
1. Up to two (2) full-time residents of the premises are allowed to conduct separate home
occupations in the same dwelling. In reviewing such a request, the local government may consider
the reason, potential residential impact, parking needs, hours of operation and other relevant
factors.
B. All home occupations other than Type I home occupations shall be considered a Type II home occupation
and shall require a special land use permit (SLUP). Additional conditions may be placed on the approval of a
Type II home occupation in order to ensure the home occupation will not be a detriment to the character of
the residential neighborhood.
1. Customer contact is allowed for Type II home occupations.
2. Up to two (2) full-time residents of the premises are allowed to conduct separate home
occupations in the same dwelling. In reviewing such a request, the local government may consider
the reason, potential residential impact, parking needs, hours of operation and other relevant
factors.
C. All home occupations shall meet the following standards:
1. There shall be no exterior evidence of the home occupation.
2. No use shall create noise, dust, vibration, odor, smoke, glare or electrical interference that would
be detectable beyond the dwelling unit.
3. The use shall be conducted entirely within the dwelling unit, and only persons living in the
dwelling unit shall be employed at the location of the home occupation.
4. No more than twenty-five (25) percent of the dwelling unit and or five hundred (500) square feet,
whichever is less, may be used for the operation of the home occupation.
5. No more than one (1) business vehicle per home occupation is allowed.
6. No home occupation shall be operated so as to create or cause a nuisance.
7. Home occupation shall not include the use of a dwelling unit for the purpose of operating any
automobile repair establishment, or car wash.
8. Occupations that are mobile or dispatch-only may be allowed, provided that any business vehicle
used for the home occupation complies with Section 6.1.3
, and is limited to one (1) business vehicle
per occupation.
Chief Executive Officer
Michael Thurmond
Director
Andrew A. Baker, AICP
BL Form 103 v.3 Revised 7.9.19
D
EPARTMENT OF PLANNING
& SUSTAINABILITY
Page 2 of 2
404.371.2155 (o)
404.371.4556 (f)
DeKalbCountyGa.gov
Clark Harrison Building
330 W. Ponce de Leon Ave
Decatur, GA 30030
D. Private educational services shall comply with home occupation standards and no more than three (3)
students shall be served at a time. Family members residing in the home are not counted towards the three
(
3)
s
tudents allowed.
I
agree to abide by the regulations listed above.
________________________________________________ ____________________
Applicant’s Signature Date
OWNER’S AUTHORIZATION
The property owner should complete this form, or a similar signed and notarized form, if the individual who
is filling the application with the County is not the property owner. If there is more than one (1) property
owner, please attach additional authorizations.
T
O WHOM IT MAY CONCERN.
(I), (We), ___________________________________________________________________________________
Name of Owners
Being (owner), (owners) of the subject property identified in this application, hereby delegate(s) authority
to
__
__________________________________________________________________________________________ to use my property as a
Name of Applicant or Representative
H
ome Based Business in accordance with Sec. 27.4.2.31 of the DeKalb County Code.
__
_________________________________ ________________________________
Notary Public Owner(s)
D
ate: ____________________________
S
tamp/Seal:
ZONING OFFICE USE ONLY
Zoning Classification:
___________________________________________________________________________________________________
APPROVED
YES NO
__________________________________________________
Print Name
______________________________________________
Signature
DATE
BL Form 103 v.3 Revised 7.9.19
DeKalb County Department of Planning & Sustainability
________________________________ ________________________________________
Business Name License #/Occupation Tax #
Business Occupation Tax Certificate
Alcohol License
AFFIDAVIT VERIFYING STATUS FOR COUNTY PUBLIC BENEFIT APPLICATION
O.C.G.A. § 50-36-1(e)(2)
By executing this affidavit under oath, as an applicant for a Business License / Occupational Tax Certificate as
referenced in O.C.G.A. § 50-36-1, from DeKalb County the undersigned applicant verifies one of the following
with respect to my application for public benefit:
Do not check more than ONE option.
1) I am a United States citizen, 18 years of age or older.
2) I am a legal permanent resident of the United States 18 years of age or older.
3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with
an alien number issued by the Department of Homeland Security or other federal immigration
agency.
My alien number issued by the Department of Homeland Security or other federal immigration
agency is: _______________________________________.
The undersigned applicant also herby verifies that he or she is 18 years of age or older and has
provided at least one secure and verifiable document, as required by O.C.G.A § 50-36-1(e)(1),
with this affidavit. The secure and verifiable document provided with this affidavit can best be
classified as: (i.e. driver’s license, I-551, I-766, Passport, etc.)
_____________________________________________________________________________________________________________________________
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, of the Official Code of the State of Georgia.
Executed on this the ____________day of ____________________, 20________.
__________________________________________________
Signature of Applicant
__________________________________________________
Printed Name of Applicant
____________________________________________________
Applicant Phone Number
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE ________ DAY OF ___________________, 20____.
______________________________________________
NOTARY PUBLIC
My Commission Expires: _________________
BL Form 101 Revised 6.30.19
DeKalb County Department of Planning & Sustainability
BUSINESS NAME LICENSE #/OCCUPATION TAX #
NUMBER OF EMPLOYEES (COMPANY-WIDE)
PRIVATE EMPLOYER AFFIDAVIT PURSUANT TO O.C.G.A. § 36-60-6(d)
By executing this affidavit under oath, the undersigned private employer verifies one of the following with
respect to its application for a business license, occupational tax certificate, or other document required to
operate a business as referenced in O.C.G.A. § 36-60-6(d):
SECTION 1. Please check only one:
(A) On January 1st of the below-signed year, the individual, firm, or corporation
employed more than ten (10) employees
1
*** If you select Section 1(A), please fill out Section 2 and then execute below.
(B) On January 1st of the below-signed year, the individual, firm, or corporation
employed ten (10) or fewer employees.
*
** If you select Section 1(B), please skip Section 2 and execute Section 3 below.
SECTION 2.
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. The undersigned
private employer also attests that its federal work authorization user identification number and date
of authorization are as follows:
Name of Private Employer
Federal Work Authorization User Identification Number
Date of Authorization
--------------------------------------------------------------------------------------------------------------------------------------------
SECTION 3.
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on _____________________________, _____, 20______ in ________________________(city), ________ (state).
Signature of Authorized Officer or Agent
Printed Name and Title of Authorized Officer or Agent
S
UBSCRIBED AND SWORN BEFORE ME
ON THIS THE DAY OF , 20____
.
NOTARY PUBLIC
My Commission Expires:
1
Sec. 15-27 Employee means an individual whose work is performed under the direction and supervision of the employer and whose
employer withholds FICA, federal income tax, or state income tax from such individual's compensation or whose employer issues to
such individual for purposes of documenting compensation a form I.R.S. W-2 but not a form I.R.S. 1099.
BL Form 102 Revised 6.30.19
Lease Agreement/
Landlord Consent
Background Information
Check
Supplemental Application
Form
Other Regulatory Agencies
Apartment Complex
Auto Dealer/ Broker
Auto Repair
Beauty Salon & Barber Shop
Catering - Share Kitchen
Convenience Stores with gas
Convenience Stores without gas
Day Cares, Personal Care Homes
Financial Services
Hotel/ Motel
Insurance
Late Night Establishments
Other Services
(Admin., Lawn, Cleaning, etc.)
Professional service
(CPA, Medical, Legal, General
Contractor, etc)
Retail Trade - Eating and
Drinking places
Retail Trade - Online Sales
Spa (Massage Parlors)
Temporary Retail Sales
(Mother's Day, Easter, etc.)
NOTE: This is not a inclusive list of all Business type/ Activity that are/will be approved in Unincorporated DeKalb County but should be used merely use as a guide to aid with the
new business license application process.
BUSINESS ACTIVITY TYPE SPECIFIC
(QUALIFICATION)
REQUIRED BY ALL BUSINESS LOCATION TYPE SPECIFIC
Business Type/ Activity
LEGEND
REQUIRED
MAYBE REQUIRED
NOT REQUIRED
DEPARTMENT OF PLANNING & SUSTAINABILITY
DEKALB COUNTY BUSINESS REGISTRATION APPLICATION CHECK LIST
Application Form
Applicant & Premises
Owner Affidavit
Affidavit Verifying Status
(SAVE)
Private Employer
Affidavit
Trade Name Required
DBA
LLCs, Corporations, etc.
Sanitation Location
Number
Home Occupation
Supplemental Form
Certificate of Occupancy
(Commercial Location)
Special Administrative
Permit (SAP) or Other
Secretary Of State
Department of
Agriculture
DeKalb Board of Health
Department of
Community Health
Code Compliance
Certificate
Applicant's Government
Identification
Page 1 of 4
v.18.0 effective 9.28.2020
330 W. Ponce de Leon Ave
Decatur, GA 30030
www.dekalbcountyga.gov/planning
Office: 404-371-2155
Chief Executive Officer
Michael Thurmond
DEPARTMENT OF PLANNING & SUSTAINABILITY
Director
Andrew A. Baker, AICP
DEKALB COUNTY
BUSINESS REGISTRATION APPLICATION INSTRUCTIONS
BUSINESS INFORMATION
BUSINESS
OWNERSHIP/ ENTITY
CHECK ONLY ONE
Sole Proprietor
Limited Liability Company (LLC)
Partnership
Corporation
Trust
Other – provide details
BUSINESS TYPE
CHECK ONLY ONE
For Profit
Non-Profit (educational or charitable organization)
FED EMPLOYER ID #
ENTER Federal Employer's Identification Number (EIN)
Issued by the Internal Revenue Service (IRS)
Used to identify business entity
GA
SALES AND USE TAX #
ENTER Georgia Sales and Use Tax Number
Issued by GA Department of Revenue
FED WORK
AUTHORIZATION #
ENTER Federal Work Authorization Identification Number
Also known as E-Verify Company ID number
Required for ten (10) or more employees, if less than 10 employees enter
“N/A”
PERMIT/ C.O.#
ENTER Permit/ Certificate of Occupancy Number
Issued by DeKalb County – Planning and Sustainability
REQUIRED FOR ALL COMMERCIAL LOCATION TYPES
LOCATION TYPE
CHECK ONLY ONE
Homebased (Using residential address as physical address)
Home Occupation Supplemental Registration Form required
Commercial (Zoning requirements apply and may be subject to SLUP)
Certificate of Occupancy Required
(Physical location of the business and/or principal office address)
SANITATION
PROVIDER NAME
ENTER “DEKALB COUNTY” or the name of the Private Sanitation Company
Provider
DEKALB COUNTY
SANITATION #
ENTER DeKalb County Sanitation Location Number if DeKalb County Sanitation
is provider, if not ENTER “N/A”
LEGAL/ ENTITY
NAME
ENTER Legal Name for sole proprietor or entity name registered with the
Secretary of State
TRADENAME/ DBA
NAME
ENTER tradename if doing business different from legal/entity name
Trade Name MUST be registered with Clerk of Superior Court of DeKalb
County, or provide franchise agreement
PRIMARY LINE OF
BUSINESS TO BE
CONDUCTED
ENTER Description of Dominant Line of Business Conducted.
Refer to the NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM
(NAICS) for classifying business establishments
Page 2 of 4
v.18.0 effective 9.28.2020
PRIMARY LINE OF
BUSINESS TO BE
CONDUCTED
(continued)
Line of Business which the greatest amount of amount of income is derived
Line of Business which the Occupation Tax category will be based on
OTHER LINE OF
BUSINESS TO BE
CONDUCTED
ENTER Description of Other Line of Business Conducted.
Line of business MUST also comply with zoning requirements of property
PHONE ENTER primary business phone number
EMAIL ENTER primary business email address
PHYSICAL
(LOCATION)
ADDRESS
ENTER Physical address or location of business within county limits
(UNINCORPORATED DEKALB COUNTY ONLY)
PO BOX NOT PERMITTED HERE
Office where a business, profession, or occupation is conducted or where
services are provided
BILL TO/MAILING
ADDRESS
ENTER mailing or billing address
PO BOX PERMITTED HERE
APPLICANT’S INFORMATION
APPLICANT
(INDIVIDUAL)
FIRST & LAST NAME
DRIVER’S LICENSE #:
CHECK BOX, if applicant is an individual
ENTER Individual’s First and Last Name.
MUST MATCH driver’s license.
ENTER driver’s license number
INDIVIDUAL APPLICANT ONLY
APPLICANT
(BUSINESS ENTITY)
LEGAL AND
TRADENAME
STATE OR
JURISDICTION
REGISTERED
CHECK BOX ONLY, if applicant is a business entity
ENTER legal entity and Trade Name
MUST BE REGISTERED AND ACTIVE
ENTER state or jurisdiction where business entity is registered with the secretary
of state
PHONE ENTER applicant’s phone number
EMAIL ENTER applicant’s email address
ADDRESS ENTER applicant’s address
MUST MATCH driver’s license of applicant
TITLE/ POSITION ENTER Applicant’s corporate officer Title and Position
AUTHORIZED AGENT
CHECK ONLY ONE
YES, authorized to receive legal process and notices on behalf of business
If NO, provide description of business relationship
OWNERSHIP INFORMATION
List EACH owner with 10% or more ownership interest.
SKIP if applicant is sole owner with 100% ownership interest.
OWNER 1
(INDIVIDUAL)
FIRST & LAST NAME
DRIVER’S LICENSE #:
CHECK BOX, if owner 1 is an individual
ENTER Individual’s First and Last Name.
MUST MATCH driver’s license.
ENTER driver’s license number
INDIVIDUAL APPLICANT ONLY
OWNER 1
(BUSINESS ENTITY)
LEGAL AND TRADE
NAME
CHECK BOX, if owner 1 is a business entity
ENTER legal entity and Trade Name
MUST BE REGISTERED AND ACTIVE
Page 3 of 4
v.18.0 effective 9.28.2020
STATE OR
JURISDICTION
REGISTERED
(continued)
ENTER state or jurisdiction where business entity is registered with the secretary
of state
PHONE ENTER owner 1 phone number
EMAIL ENTER owner 1 email address
ADDRESS ENTER owner 1 address
TITLE/ POSITION ENTER owner 1 corporate officer Title and Position
OWNERSHIP
INTEREST
PERCENTAGE (%)
ENTER owner 1 ownership interest of the business as a percentage.
OWNER 2
(INDIVIDUAL)
FIRST & LAST NAME
DRIVER’S LICENSE #:
CHECK BOX, if owner 2 is an individual
ENTER Individual’s First and Last Name.
MUST MATCH driver’s license.
ENTER driver’s license number
INDIVIDUAL APPLICANT ONLY
OWNER 2
(BUSINESS ENTITY)
LEGAL AND TRADE
NAME
STATE OR
JURISDICTION
REGISTERED
CHECK BOX, if owner 2 is a business entity
ENTER legal entity and Trade Name
MUST BE REGISTERED AND ACTIVE
ENTER state or jurisdiction where business entity is registered with the secretary
of state
PHONE ENTER owner 2 phone number
EMAIL ENTER owner 2 email address
ADDRESS ENTER owner 2 address
TITLE/ POSITION ENTER owner 2 corporate officer Title and Position
(Attach Additional
Sheet(s) As Needed)
Complete and Attached additional sheet(s) as needed for business with more than
two owners. (Please provide the same information required for owner 1 & 2)
TOTAL NUMBER OF
OWNERS
ENTER the sum of the number of owners.
TOTAL OWNERSHIP
INTEREST
PERCENTAGE (%)
ENTER the sum of the percentage of the ownership interest.
MUST EQUAL TO 100%
BUSINESS OCCUPATION TAX
LINE 1
GEORGIA GROSS
RECEIPTS
ENTER Current year Estimated Gross Receipts as defined by DeKalb County
Ordinance Section 15-27(9).
LINE 2
EXEMPTION
$20,000.00 Allowance
LINE 3
TAXABLE GROSS
RECEIPTS
Subtract LINE 2 from LINE 1, If Negative ENTER “0”
LINE 4
GROSS RECEIPT TAX
Use the DeKalb County Business Occupation Tax Table to get the
Gross Receipt Tax Rate that corresponds to the first three (3)
digits of your NAICS CODE, which describes the primary business
activity.
ENTER Gross Receipt Tax Rate identified in STEP 1.
STEP 2
STEP 1
Page 4 of 4
v.18.0 effective 9.28.2020
LINE 4
GROSS RECEIPT TAX
(continued)
Multiply LINE 3 by Gross Receipt Tax Rate entered in STEP 2. (if the
total is more than $50,000.00 ENTER ($50,000.00)
LINE 5
EMPLOYEE/
PRACTITIONER
Select ONLY one. (Employee Fee or Professional election.)
ENTER number of Employee(s) or Practitioner(s) (At least one (1),
including owner or operator)
ENTER Employee Rate which corresponds with the first three (3)
digits of your NAICS CODE from the DeKalb County Business
Occupation Tax Table or;
ENTER Practitioner Rate of $400.00
Multiply the number of Employee(s) or Practitioner(s) identified on
LINE 5, STEP 2, by Employee Rate or Practitioner Rate LINE 5,
STEP 3
PRACTITIONER as defined Sec. 15-27(17). The following Fees are NOT
INCLUDED if Practitioner’s election is made;
GROSS RECEIPT TAX (LINE 4)
ADMINISTRATIVE FEE (LINE 6)
FLAT FEE (LINE 7)
LINE 6
ADMINISTRATIVE FEE
$75.00 (Nonrefundable or Nontransferable)
LINE 7
FLAT TAX FEE
$50.00 FEE
LINE 8
TOTAL TAX DUE
Enter Sum Lines 4, 5, 6 & 7
APPLICANT’S ACCEPTANCE AND ACKNOWLEDGEMENT
PRINT APPLICANT’S
NAME
ENTER applicant’s First and Last Name (Print)
APPLICANT’S
SIGNATURE
Applicant’s Signature
DATE ENTER Date application executed
THE FOLLOWING OPTIONS ARE AVAILABLE FOR YOU TO SUBMIT YOUR FORMS AND PAY YOUR FEES:
Option 1 – Register an Online Account and upload All required Documents
https://dekalbga-ws01.cloud.infor.com/IPSProdDP/Views/AgencyLogin.aspx
After uploading application allow up to 5 business days to view Tax/ Fees payment due.
Option 2 – Submit Forms and Payment via Mail
Complete and submit the application along with the required documentation and payment to DeKalb County
Business License P.O. Box 100020 Decatur, GA. 30031-7020. Once received, allow two (2) weeks for review and
processing.
Option 3 – Submit Forms and Payment in Person
Complete and bring your application along with the required documentation and payment to 330 W. Ponce de
Leon Ave. 2nd floor Decatur, GA 30030. Intake will review the application for completeness. Please allow one (1)
week for the final review after submission.
ALL APPROVED BUSINESS LICENSE WILL BE MAIL AND/OR EMAIL.
STEP 3
STEP 1
STEP 2
STEP 3
STEP 4
OR
DEKALB COUNTY BUSINESS OCCUPATION TAX TABLE
Page 1 of 2 v.17 effective 6.09.20
First Three
(3) Digits of
NACIS CODE
Gross Receipts
Tax Rate
Employee
Fee
Description of Primary Business Activity Tax Class
111
0.0009
$10.00
Crop Production
4
112
0.0007
$8.00
Animal Production
3
113
0.0009
$10.00
Forestry and Logging
4
114
0.0009
$10.00
Fishing, Hunting and Trapping
4
115
0.0013
$14.00
Crop Production Support Activities
6
153
0.0009
$10.00
Forestry Support Activities
4
211
0.0011
$12.00
Oil and Gas Extraction
5
212
0.0009
$10.00
Metal Ore Mining
4
213
0.0009
$10.00
Mining Support Activities
4
221
0.0005
$6.00
Electric, Gas, and Sanitary Services
2
233
0.0007
$8.00
Construction‐Building, Developing and General Contractors
3
234
0.0007
$8.00
Heavy Construction Other Than Building‐Contractors
3
235
0.0007
$8.00
Construction‐Special Trade Contractors
3
311
0.0005
$6.00
Manufacturing ‐ Food
2
312
0.0009
$10.00
Manufacturing‐Beverage and Tobacco Product
4
313
0.0009
$10.00
Manufacturing‐Textile Mills
4
314
0.0009
$10.00
Manufacturing‐Textile Product Mills
4
315
0.0009
$10.00
Manufacturing‐Apparel
4
316
0.0007
$8.00
Manufacturing‐Leather and Leather Products
3
321
0.0007
$8.00
Manufacturing‐Lumber and Wood Products, Excepts Furniture
3
322
0.0007
$8.00
Manufacturing‐Paper and Allied Products
3
323
0.0011
$12.00
Manufacturing‐Printing, Publishing and Allied Industries
5
324
0.0007
$8.00
Manufacturing‐Petroleum and Coal Products
3
325
0.0013
$14.00
Manufacturing‐Chemicals and Allied Products
6
326
0.0005
$6.00
Manufacturing‐Plastics and Rubber Products
2
327
0.0007
$8.00
Manufacturing‐Stone, Clay, Glass and Concrete Products
3
331
0.0009
$10.00
Manufacturing‐Primary Metal Industries
4
332
0.0011
$12.00
Manufacturing‐Fabricated Metal Products, Except Machinery & Transport
5
333
0.0009
$10.00
Manufacturing‐Machinery, Except Electrical
4
334
0.0009
$10.00
Manufacturing‐Computer and Electronic Product
4
335
0.0007
$8.00
Manufacturing‐Electrical Equipment, Appliance and Component
3
336
0.0013
$14.00
Manufacturing‐Transportation Equipment
6
337
0.0009
$10.00
Manufacturing‐Furniture and Fixtures
4
339
0.0009
$10.00
Manufacturing‐Miscellaneous Manufacturing Industries
4
421
0.0003
$4.00
Wholesale Trade‐Durable Goods
1
422
0.0005
$6.00
Wholesale‐Trade‐Nondurable Goods
2
441
0.0003
$4.00
Retail Trade‐Motor Vehicle Parts Dealers
1
442
0.0007
$8.00
Retail Trade‐Home Furniture, Furnishings, and Equipment Stores
3
443
0.0007
$8.00
Retail Trade‐Electronics and Appliance Stores
3
444
0.0007
$8.00
Retail Trade‐Building Materials, Hardware, Garden Supply Dealers
3
445
0.0007
$8.00
Retail Trade‐Food Stores
3
446
0.0007
$8.00
Retail Trade‐Health and Personal Care Stores
3
447
0.0005
$6.00
Retail Trade‐Gasoline Service Stations
2
448
0.0007
$8.00
Retail Trade‐Apparel and Accessory Stores
3
451
0.0007
$8.00
Retail Trade‐Sporting Goods, Hobby, Book and Music Stores
3
452
0.0007
$8.00
Retail Trade‐General Merchandise Stores
3
453
0.0007
$8.00
Retail Trade‐Miscellaneous Stores
3
454
0.0007
$8.00
Retail Trade‐Non store Retailers, Not Elsewhere Classified
3
481
0.0005
$6.00
Air Transportation
2
482
0.0003
$4.00
Railroad Transportation
1
483
0.0005
$6.00
Water Transportation
2
484
0.0009
$10.00
Truck Transportation
4
485
0.0003
$4.00
Transit and Ground Passenger Transportation
1
486
0.0005
$6.00
Pipeline Transportation, Except Natural Gas
2
487
0.0003
$4.00
Scenic and Sightseeing Transportation
1
488
0.0013
$14.00
Transportation Support Activities
6
492
0.0013
$14.00
Couriers and Messengers
6
493
0.0009
$10.00
Warehousing and Storage
4
511
0.0011
$12.00
Publishing Industries
5
DEKALB COUNTY BUSINESS OCCUPATION TAX TABLE
Page 2 of 2 v.17 effective 6.09.20
First Three
(3) Digits of
NACIS CODE
Gross Receipts
Tax Rate
Employee
Fee
Description of Primary Business Activity Tax Class
512
0.0009
$10.00
Motion Pictures and Sound Recording Industries
4
513
0.0003
$4.00
Broadcasting and Telecommunications
1
514
0.0013
$14.00
Information and Data Processing Services
6
522
0.0013
$14.00
Credit Intermediation and Related Activities
6
523
0.0013
$14.00
Investment and Commodity
6
524
0.0013
$14.00
Insurance Carriers (Underwrites)
6
525
0.0013
$14.00
Funds, Trusts and Other Financial Vehicles
6
531
0.0013
$14.00
Real Estate
6
532
0.0009
$10.00
Rental and Leasing Services
4
533
0.0013
$14.00
Lessors of Other Non‐financial Intangible Asset
6
541
0.0013
$14.00
Professional, Scientific and Technical Services
6
551
0.0013
$14.00
Management of Companies and Enterprises
6
561
0.0013
$14.00
Administrative and Support Services
6
562
0.0009
$10.00
Waste Management and Remediation Services
4
611
0.0013
$14.00
Educational Services
6
621
0.0013
$14.00
Health Practitioners
6
622
0.0013
$14.00
Hospitals
6
623
0.0013
$14.00
Nursing and Residential Care Facilities
6
624
0.0013
$14.00
Social Services
6
711
0.0013
$14.00
Perform Arts, Spectator Sports and Related Industries
6
712
0.0011
$12.00
Museums, Historical Sites
5
713
0.0013
$14.00
Amusement, Dance, Theater, and Sports
6
721
0.0007
$8.00
Hotels, Motels, Campgrounds
3
722
0.0007
$8.00
Retail Trade‐Eating and Drinking Places
3
811
0.0009
$10.00
Repair and Maintenance
4
812
0.0013
$14.00
Dry‐cleaning and Laundry Services
6
813
0.0009
$10.00
Civic and Social Organizations
4
814
0.0013
$14.00
Private Households
6
PROFESSIONALS ELECTION O.C.G.A 48-13-9 (c)(2)
First Three
(3) Digits of
NACIS CODE
Gross Receipts
Tax Rate
Professional
Rate
Description of Primary Business Activity Tax Class
541
0.00
$400.00
Professional, Scientific and Technical Services
7
621
0.00
$400.00
Health Practitioners
7
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DEKALB COUNTY BUSINESS REGISTRATION APPLICATION (DeKalb County Government)

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Completed 28 December 2022

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