July, 2012 1
Secondary Metals Recycler Registration Form
Pursuant to O.C.G.A. § 10-1-360, beginning July 1, 2012, secondary metals recyclers who purchase regulated metal
property in any quantity must register with the appropriate sheriff’s office or offices.
To Determine the County of Registration
Business (Corporation or Partnership)
If you are registering as a business, you must register with the sheriff in each county where you maintain a place of
business. If you maintain a place of business in more than one county, you must file a separate registration form for
each business location.
Individual (Sole Proprietor)
If you are registering as an individual, you must register in the county where you reside.
Non-resident of Georgia
If you are not a resident of Georgia, you must register in the county where you primarily engage or intend to engage
in business as a secondary metals recycler.
The Registration Process
Obtain a copy of the Secondary Metals Recycler Registration form online at _________________________________
or by visiting the __________________________ County Sheriff’s Office.
Complete and submit the registration form in person to the appropriate sheriff’s office or offices.
Application for registration must include:
Non-Refundable Registration Fee
Submit payment of $200 with the registration form; the payment must be made by check or money order payable
to the ___________________ County Sheriff’s Office. Checks returned for insufficient funds are subject to a $30
service charge pursuant to O.C.G.A. § 16-9-20.
Identification
Citizenship / Qualified Alien Status
If you are a qualified alien, your Secure and Verifiable documentation must be attached to the application.
Read the instructions carefully and be familiar with the laws governing Secondary Metals Recyclers in the State of
Georgia. Visit our website for information: ___________________________________________________________
Registration
Each registration is valid for a 12 month period beginning with the effective registration date as established by the
sheriff’s office once all registration requirements are met.
Questions?
Contact ______________________________ at your local sheriff’s office at ________________________________.
Contact ______________________________ at your local sheriff’s office at ________________________________.
Contact ______________________________ at your local sheriff’s office at ________________________________.
This is an official document and may not be altered, except to individualize sheriff’s office information.
www.wcsoga.com
Wayne
Wayne
www.wcsoga.com
Records Section
912-427-5970
WAYNE COUNTY SHERIFF'S OFFICE
July, 2012 2
Secondary Metals Recycler Registration
County Where Business is Located: ___________________
If you are registering in multiple counties, please complete a registration form for each county where you have a location.
Name of Corporation or Partnership (if
applicable)__________________________________________________________________
Full Name of Individual Registering __________________________________________________________________
(Please print)
First Middle Last
Physical Address ____________________________________________________________________________
Provide street address; include apartment number if applicable. (P.O. Box not acceptable; must be a physical street
address in Georgia where an individual can be located in-person for the company.)
_______________________________________________________________________________________________
City / State / Zip
Mailing Address _____________________________________________________________________________
If different from above, provide street address; include apartment number if applicable; or, provide P.O. Box.
_______________________________________________________________________________________________
City / State / Zip
Contact Information _______________________________________________________________
Email
_________________________ _________________________ __________________________
Day Telephone Number Evening Telephone Number Cell Number
If the on-site manager is different from the above, complete the following information for the person who is currently
the active on-site manager of the business.
Name of the On-Site Managing Agent _______________________________________________________________
(Please print)
First Middle Last
Physical Address ____________________________________________________________________________
Provide your street address; include apartment number if applicable. (P.O. Box not acceptable.)
_______________________________________________________________________________________________
City / State / Zip
Contact Information _______________________________________________________________
Email
_________________________ _________________________ __________________________
Day Telephone Number Evening Telephone Number Cell Number
Attach registration fee: $200 (Non-refundable.) The fee for checks returned due to non-sufficient funds is $30.00.
Provide a copy of your identification.
The period of registration shall be for one year. A new registration form and annual fee must be submitted to the sheriff of
the county where the business is located or the individual resides by the expiration date of the preceding year. If the
person fails to register annually on or before the date of registration, he/she shall be guilty of a misdemeanor of a high
and aggravated nature.
WAYNE COUNTY SHERIFF'S OFFICE
July, 2012 3
Secondary Metals Recycler Registration Registrant Affidavit
I hereby swear and affirm that all information provided in this registration form is true and correct to the best of my
knowledge and belief. I further swear and affirm that I have read and understand the current state laws relating to
secondary metals recyclers in Georgia and I agree to abide by these laws, as amended from time to time.
By signing this application, I hereby swear and affirm one of the following to be true and accurate pursuant to O.C.G.A. §
50-36-1:
1. _______ I am a United States citizen 18 years of age or older. Please submit a copy of your current Secure
and Verifiable Document(s) such as driver’s license, passport, or other approved documentation.
2. _______ I am not a United States citizen, but I am a legal permanent resident of the United States 18 years of age
or older, or I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years
of age or older with an alien number issued by the Department of Homeland Security or other federal immigration
agency. Please submit a copy of your current immigration document(s) which includes either your Alien number
or your I-94 number and, if needed, SEVIS number.
By signing below, I acknowledge that I understand that I must comply with all Georgia laws relevant to secondary metals
recyclers at all times.
I am informed of the statutes pertaining to the Secondary Metals Recyclers pursuant to HB872, and the following
statutes O.C.G.A. § 10-1-350 through O.C.G.A. § 10-1-363, O.C.G.A. § 40-3-36, O.C.G.A. § 40-3-56.
I acknowledge that I understand the definition of secondary metals recycler as defined in O.C.G.A. § 10-1-350.
'Secondary metals recycler' means any person who is engaged, from a fixed location or otherwise, in the business in this
state of paying compensation for regulated metal property that has served its original economic purpose, whether or not
engaged in the business of performing the manufacturing process by which regulated metal property is converted into raw
material products consisting of prepared grades and having an existing or potential economic value.
I understand I may visit www.georgiarecyclers.org for a summary of the laws relevant to Georgia secondary
metals recycler information provided by The Georgia Recyclers Association but I understand that this summary
does not substitute the advice of legal counsel or reading of the actual laws.
In making the above attestation, I understand that making any false statements or writings on any part or portion of this
application is a violation of O.C.G.A. 16-10-20. Failure to make full and accurate disclosures may result in criminal
prosecution.
_____________________________________________________ _____________________________________
Signature of Individual Completing Registration Application Date
_____________________________________________________
Print Individual Completing Registration Application
TO BE COMPLETED IN THE PRESENCE OF THE SHERIFF OR HIS DESIGNEE UPON
SUBMISSION OF THIS APPLICATION TO THE APPROPRIATE SHERIFF’S OFFICE
_______________________________________________ __________________
Secondary Metals Recycler Signature Date
_______________________________________________ __________________
Sheriff or Sheriff’s Designee Signature Date
_______________________________________________ ________________________________
Effective Date of Registration Expiration Date of Registration
__________________________________________
Registration Number
WAYNE COUNTY SHERIFF'S OFFICE
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