Unit/Suite State Zip Code
Unit/Suite State Zip Code
E-Mail
Unit/Suite State Zip Code
Unit/Suite State Zip Code
Phone
State Card # Expiration Issued To
NAICS Tax Identification #
E-Verify # GA Sales Tax #
16-25 $500.00
26-50 $750.00
I swear under penalty of law that the above information is true and 51-100 $1,000.00
correct. I understand that this is a tax certificate. I must separately 101+ $10.00 each
comply with any zoning, Fire Marshal, Health, or other rules. I
understand that information I provide herein (or my refusal to Date
provide required information) will be shared with the Georgia
Department of Revenue.
Zoning District
DateFinance Signature Date Planning & Zoning Signature
Planning & Zoning Use:
District Land Lot
Finance Department Use:
License #
Signature of Business Owner
Annual Tax Schedule
11-15 $375.00
7-10 $250.00
4-6 $150.00
0-3 $75.00
Maximum Tax $1,500.00
Fayetteville, GA 30214
Make Checks Payable to Fayette County
*Documentation is required
Bring Completed Application & Payment:
check, cash, or credit card to:
140 Stonewall Avenue West, Suite 101
Business Type
OCCUPATION TAX CERTIFICATE APPLICATION
Exemptions
# Employees
Form of Ownership
Do you hold a state license for your occupation?
Phone Emergency Contact 2
Property Owner City
Emergency Contact 1
Owner Address City
PhoneCo OwnerOwner Name
Mailing Address (if different) City
Physical Address
FOR BUSINESSES LOCATED IN FAYETTE COUNTY ONLY
RENEWAL DUE BY JANUARY 31 EACH YEAR
Business Name DBA (if different) Phone
City
Yes (Documentation Required) No
Home Occupation
Commercial
Sole Proprietor
Limited Liability Corporation*
General Partnership
Proprietorship
Corporation*
Partnership-unknown type
Non Profit 501 c 3*
Disabled Veteran*
New
Update
Cash Check #
Credit/Debit CardMoney Order
Allowable for Business Use
Not Allowable for Business Use
BOTSS Reporting
click to sign
signature
click to edit
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