DeKalb County Department of Planning & Sustainability
Effective Date 9.11.2020
BUSINESS LICENSE RENEWAL AFFIDAVIT – 20______
The undersigned, __________________________________________________________, being duly sworn, says the following:
1. Have there been changes of ownership of the establishment? ☐ Yes ☐No If yes, please explain
2. There have been no changes in any information and data contained in and furnished with my original
DeKalb County Business Registration application.
3. In the past year, have you been convicted of or pleaded nolo contendere to a violation of any federal,
state, or county law concerning crime of moral turpitude, misdemeanor, or violation of this Code
directly relates to the business for which the certificate is sought? If yes, please explain the violation
and provide the date of adjudication and the court of adjudication:
4. I am familiar with all laws, rules and regulations of the State of Georgia and all ordinances of DeKalb
County covering the operation of the business establishment I will operate under this renewal.
I swear that all the information contained in the original application is true and I understand that
such application is made a part of this renewal application and the renewal is based upon the
information contained in the original application. DeKalb County sec. 15-45(a). A license issued
pursuant to the provisions of this division shall be denied, suspended or revoked by the director if
the licensee furnishes fraudulent or untruthful information in the original, renewal or transfer
application for a license or omits information required in the original, renewal or transfer application
for a license and for failure to pay all fees, taxes or other charges imposed under the provisions of this
Sworn to and subscribed to before me
this_____________ day of _________________,20____.
My commission expires:
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