Fillable NEW BUSINESS LICENSE APPLICATION **REQUIRED** (Fulton County Government)

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NEW BUSINESS LICENSE APPLICATION **REQUIRED** (Fulton County Government)

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BROWSE FULTON COUNTY GOVERNMENT (GA) FORMS

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Avenu Account: NEW
Affidavit Verifying Status of Benefit Applicant
Pursuant to the Georgia Security and Immigration Compliance Act (O.C.G.A 50-36-1), effective July 1, 2007, every agency in Fulton
County providing public benefits through any local program is responsible for determining the immigration status of citizen applicants
for said benefits.
By executing this affidavit under oath, as an applicant for benefits, I am stating the following with respect to my application for benefits
from Fulton County Government:
Select one of the below.
_____________________ I am a United States citizen 18 years of age or older;
_____________________ I am a legal permanent resident 18 years of age or older;
_____________________ I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act, Title 8
U.S.C., as amended, 18 years of age or older and lawfully present in the United States. My alien number issued by the U.S.
Department of Homeland Security or other federal immigration agency is ________________________________________.
The undersigned applicant also hereby verifies that he or she 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: _____________________________________
(Please enclose legible copy of document with Affidavit.)
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.
Executed in _____________________________(city), ______________________(state).
_________________________________________ _____________________________________ ______________________
Signature of Applicant Printed Name Date
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE ______ DAY OF ______________,20_______.
_________________________________ My Commission Expires: _________________________________
NOTARY PUBLIC
Private Employer Affidavit Pursuant To O.C.G.A. § 36-60-6(d)
Effective July 1, 2013, any private company with more than 10 full-time employees, along with every public employer,
regardless of its size, must register with the federal E-Verify program to check the legal status of new hires.
By executing this affidavit, the undersigned private employer verifies it’s compliance with O.C.G.A. § 36-60-6, stating
affirmatively that the individual, firm or corporation has registered with and utilizes the federal work authorization
program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable
provisions and deadlines established in O.C.G.A. § 13-10-90. Furthermore, the undersigned private employer hereby
attests that its federal work authorization user identification number and date of authorization are as follows:
_________________________________ ___________________ ___________________________________
Federal Work Authorization User Identification Number Date of Authorization Name of Private Employer
If your business employs less than ten (10) employees, please check this box and sign below.
By checking this box and signing this form below you are stating affirmatively that your business employs less than ten (10) employees and that your
business is not required to register with and/or utilize the federal work authorization program commonly known as E-Verify.
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 of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME ON THIS THE ______ DAY OF ______________,20_______.
_________________________________ My Commission Expires: _________________________________
NOTARY PUBLIC
**FORM REQUIRED*** This form must be completed in full and returned with your Fulton County Occupational Tax Renewal and payment.
Failure to return the completed Affidavit Verifying Status of Benefit Applicant, Verifiable and Secure Document, and the Private Employer
Affidavit with your renewal and payment will delay the issuance of your occupational certificate.
**REQUIRED**
NEW BUSINESS LICENSE APPLICATION
The issuance of a Business Tax Certificate does not insure that a business can legally operate at
the subject site. This form must be submitted to the Fulton County Department of Environment and
Community Development as part of the application process in order to verify that the subject site is
zoned appropriately for the applicant’s business type.
Business Name:
Business Address:
City, State, and Zip Code:
Business Phone: Fax:
Type of Business (Primary):
Description and Nature of Business:
Will you be storing any materials pertaining to the business at the Business Address listed above?
YES NO (If yes, please list materials):
GA Corporation
Foreign Corporation
Sole Owner Partnership
Other
Owner’s Name:
City, State, Zip:
Type of Ownership:
Corporate Name:
Mailing Address:
Primary Contact:
Phone:
I, the undersigned, verify that the information completed on this form is true and correct to the best
of my knowledge.
CUSTOMER SIGNATURE:
*IF BUSINESS IS HOME-BASED, PLEASE REVIEW FORM ON REVERSE SIDE ARTICLE 4.12
(HOME OCCUPATION REGULATIONS) AND SIGN.
ENCLOSED BOX AREA FOR OFFICE USE ONLY
1.
The above address is zoned
and can be utilized for the legal operation of the
applicant’s referenced business type.
2.
The above address is zoned and CANNOT be utilized legally for the operation
of the applicant’s referenced business type.
Staff Signature:
Date:
BUSINESS OCCUPATIONAL TAX CERTIFICATE ZONING
CONFIRMATION FORM
Date:
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4.12 - Home occupation. (Added 12/4/91)
A home occupation is permitted as an accessory use of a dwelling unit in any zoning district and its
operation and employees are limited to members of the resident family only. The following are
limitations on home occupations:
A. The smaller of 25 percent or 750 square feet of the gross floor area of a dwelling unit may be
used for activities devoted to the home occupation.
B. Accessory buildings and structures may not be used for the home occupation.
C. There shall be no signs identifying the home occupation, nor shall there be any storage,
display or activity associated with the home occupation visible outside the structure.
(Amended 03/03/04)
D. Said uses are excluded: auto repair or similar operations, restaurants, keeping of animals,
funeral homes, retail or wholesale shops, motel type establishments, taxi services, or any
other occupation found incompatible with the intent of this resolution. (Amended 03/03/04)
E. Resident participants in a home occupation must have the appropriate occupational licensing,
including business licenses.
F. No home occupation shall generate traffic, sound, smell, vibration, light, or dust that is
offensive.
G. No more than two clients or patrons are allowed on the premises at the same time in
conjunction with the home occupation (except for persons in care at a family day care homes,
where no more than six clients are allowed).
H. Vehicles kept on site in association with the home occupation shall be used by residents only.
I. The transporting of goods by truck is prohibited. Incoming vehicles related to the home
occupation shall be parked off-street within the confines of the residential driveway or other
on-site permitted parking.
J. Home occupations must exclude the use of instruments, machinery or equipment that emit
sounds (i.e. musical instruments, sewing machines, saws, drills) that are detectable beyond
the unit.
K. Family day care homes are prohibited within multifamily dwelling units.
L. Family day care homes shall provide outdoor play areas as required by Georgia law, but such
areas shall be limited to side or rear yards outside the minimum yard area, and shall not
occupy any yard adjoining a street.
M. Family day care home shall be located at least 1,000 feet in all directions from any other such
use operated as a home occupation.
N. Family day care home hours of operation shall be limited to Monday through Saturday from
6:00 a.m. to 7:00 p.m.
O. Family day care home operators shall have a current, certified copy of the operator's State of
Georgia Family Day Care Home registration which shall be filed with the business license
application and renewals.
P. No home occupation shall be operated so as to create or cause a nuisance.
Avenu Account # _NEW Business Name: _____________________________________________________
NAIC No.: Fee Class: Rate: State Sales Tax ID#______________
Please provide Sales Tax ID #.
Mailing Address (Changed? Please provide correction below)
Physical Address (Changed? Please provide correction below)
NAME
ADDRESS
ADDRESS
BUSINESS TAX DIVISION NEW WORKSHEET
Failure to Submit Application, Affidavits, Certifications as needed, and Fees By March 31
st
of Each Year Will Result in Penalties, Interest and additional
fees as applicable.
Note: *(+ or -) means calculation could be positive or negative
I do solemnly swear that the information on this application is true, correct to the best of the applicant’s knowledge, training, and ability, 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 that I may be subject to criminal prosecution and/or immediate revocation of my business occupational tax certificate issued as a result of
this application. I understand that I must comply with all city and state 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. All tax certificates expire December 31 and must be renewed
annually.
___________________________________________________________________________________________________________
Printed Name Date Email Address
________________________________________________________________________________________
Signature Title
___________________________________________________________________________________________________________
Business Name FEIN
Failure to return all documentation including board certification and the affidavits can result in a delay of the issuance of the license.
TABLE 1: PREVIOUS YEAR CALCULATIONS:
XXXX
Complete the below as needed
A. NEW
(If $20,000 or less, put “20,000”)
$ NEW
Required: Is your business an adult
entertainment establishment (sexually oriented
business) as defined by the Municipal Code, or
does it offer any form of adult entertainment?
Yes:________ No:________
a. Sales, Use or Excise Tax
b. Inter-organizational Sales
c. Payments to Sub-Contractors or Independent Agents**
d. Out of State Sales
e. Sales Returns and Allowances
Are you a professional practitioner electing to
pay a flat fee of $400 per practitioner? Only
Professional practitioners described in O.C.G.A. § 48-13-
9(c)(1-18) can opt to pay the $400 flat fee.
# of Practitioners ______________ x $400.00
Total Due: $__________________________
f. Total Deductions (add a through e)
B. Subtract Deductions from Actual Gross Receipts (A&F)
(Total cannot be less than $20,000.00)
$
C. PRIOR YEAR Estimated Gross Receipts
$
D. Gross Receipts Adjustment = Line B - Line C (+ or -)
E. Tax Adjustment = Line D x RATE (+ or -)
F. PRIOR YEAR Actual Employees (At least one)
**Payment to sub-contractors or Independent
Agents - Individuals or Companies who contribute to
the gross receipts of the business. Examples:
Salon/Barber Business, Construction Business, etc.
Provide name, address, phone and dollar amount
on a separate sheet of paper.
G.PRIOR YEAR Estimated Employees
xx
H. Employee Adjustment = Line F – Line G (+ or -)
I. Employee Fee Adjustment = Line H x Rate (+ or -)
J. Total Adjustment = Line E + I (+ or -)
TABLE 2: CURRENT YEAR ESTIMATES
20_____
1. 20______ Estimated Gross Receipts
(If $20,000.00 or less, put “20,000”)
$
Business Closed or Moved? Complete Table 1 to
ensure no additional amount is due. Provide date
business closed, sign and return with any
additional amount owed.
Date Closed/Moved:_____________________
a. Sales, Use or Excise Tax
b. Inter-organizational Sales
c. Payments to Sub-Contractors or Independent Agents**
d. Out of State Sales
e. Sales Returns and Allowances
Address Change:
____________________________________
____________________________________
____________________________________
f. Total Deductions (add a through e)
2. Subtract Deductions from Est. Gross Receipts (1&F)
(Total cannot be less than $20,000.00)
$
3. Standard Deduction
$20,000.00
4. Subtract Line 3 from Line 2 (use 0 if amount negative)
5. Multiply Line 4 x RATE
If the primary business activity has changed, enter
the new business description below:
________________________________________
6. Est. Number of Employees _____ x RATE (At least one)
7. Flat Fee
$50.00
8. Administrative Fee
$95.00
9. Previous Year Adjustment (Table 1 Line J) (+ or -)
ALL NEW APPLICANTS MUST come in:
FULTON COUNTY GOVERNMENT BUILDING:
141 PRYOR STREET SUITE 7067
ATLANTA, GA 30303
BUSINESS LICENSE DIVISION
Phone:404-612-7722
Phone:
11. Penalty (10% of Line 10) (If Paid After March 31
st
)
12. Interest (1% of Line 10 - Per Month) (If Paid After March 31
st
)
13. GRAND TOTAL DUE (add Lines 10 -12)
$
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Sec. 18-41. - Payment; penalty for late payment; issuance of executions against delinquent taxpayers.
(a) Any occupation tax with its associated administrative fees hereunder, shall be due and payable by
March 31 of each calendar year. If the business or practice was not in operation on January 1, the
occupation tax with its associated administrative fees shall be due and payable 30 days following
the commencement of business pursuant to section 18-38. The department of finance shall assess a
penalty in the amount often percent of the amount owed for each calendar year or portion thereof
for:
(1) Failure to pay occupation taxes and administrative fees when due;
(2) Failure to file an application by March 31 of any calendar year, when the business or
practitioner was in operation on January 1 or such calendar year; and/or
(3) Failure to register and obtain an occupation tax certificate within 30 days of the
commencement of a new business.
Delinquent taxes and fees are subject to interest at a rate of one and one-half percent per month.
Payments required by this article may be collected in any suit at law or in equity, or the department
of finance may cause executions to issue against the person, firm or corporation liable for the
payment. Executions may be levied and sold together with all costs thereof, by the director of
finance, as ex-officio sheriff of the county. Any person whose duty it is to register any business or
practice and obtain any occupation tax certificate required under this article and falls to do so, or
who fails to pay the occupation tax or administrative fee required by this article, or who makes any
deliberate or substantial and material false statement on an application or provides materially false
information in support of an application, shall be denied an occupation tax certificate, shall be
required to surrender any existing such occupation tax certificate shall be subject to a civil fine as
provided by the law of this state.
(b) No business or practitioner subject to this article shall collect any gross receipts as defined herein
unless such business or practitioner shall have applied for an occupation tax certificate and/or license as
required hereunder. Upon application for an occupation tax certificate, any such business or practitioner
may thereupon collect gross receipts, including those incurred but not collected during the period prior to
the application, but such business or practitioner shall be subject to the penalties of subsection (a) of this
section. If the taxes and fees remain unpaid after the due date, the business or practitioner shall not collect
any gross receipts as defined herein. The provisions of this subsection (b) may be enforced by appropriate
injunctive or other relief upon the application of the director of finance to the Superior Court of Fulton
County.
(c) Practitioners of law may collect gross receipts as defined herein without applying for and obtaining an
occupation tax certificate. However, practitioners of law must pay the occupation tax levied herein.
Delinquent taxes and fees are subject to interest at a rate of one and one-half percent per month. Any
occupation tax with its associated administrative fees hereunder, shall he due and payable by March 31 of
each calendar year. If the business or practice was not in operation on January 1, the occupation tax with its
associated administrative fees shall be due and payable 30 days following the commencement of business
pursuant to section 18-38. The department of finance shall assess a penalty in the amount of ten percent of
the amount owed for each calendar year or portion thereof for failure to pay occupation taxes and
administrative fees when due. In the event of failure to pay the occupation tax required by this article, the
tax may be collected in any suit at law or in equity. In addition, failure to pay the occupation tax required
by this article shall subject the person, firm or corporation to a civil fine as provided by the law of this
state.
(Res. No. 06-0467, Exh. A, 5-3-06)
Sec. 18-42. - Display of occupation tax certificate; penalty for failure to display.
The certificate holder is required to display the occupation tax certificate issued hereunder in a conspicuous
location. Failure to display the occupation tax certificate in a conspicuous location may result in a fine of
$100.00. This section does not apply to practitioners of law.
(Res. No. 06-0467, Exh. A, 5-3-06; Res. No. 11-0075, 1-19-11)
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NEW BUSINESS LICENSE APPLICATION **REQUIRED** (Fulton County Government)

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Completed 17 July 2020

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