Occupational Tax Certificate Application

Instructions for Completing the Occupational Tax Certificate Application.

Answer all questions in the application. For those questions that do not apply, enter "N/A".

Print the application using the print button on the last page of the application.

Make sure that the application is SIGNED and NOTARIZED.

This form has been modified since it was saved. Please review all fields before submitting.

1. Occupational Tax Certificate This section is complete This section is incomplete
2. Occupational Tax Certificate - Certifications / Business Information This section is complete This section is incomplete

Greene County
Occupational Tax Return
1034 Silver Drive, Suite 201
Greensboro, GA 30642
Phone (706) 453-7716
Is this Business Closed?
1. Yes
2. No
Date Closed
Date Closed
Application Type
1. Renewal
1. New Business
All applications must be filled out COMPLETELTY. In complete forms will NOT be processed.
COMPANY INFORMATION
Business Name
DBA
Owner's Name
Email Address
Phone
Phone Type
1. Business
2. Home
3. Mobile
Secondary Phone
Phone Type
1. Business
2. Home
3. Mobile
4. FAX
Business Address
City
State
Zip Code
Mailing Address (if different)
City
State
Zip Code
SUB-CONTACTS
(If different from owner. May include operator/manager, etc.)
Name and Title
Phone
Phone Type
1. Business
2. Home
3. Mobile
Email Address
Do you have another sub-contact to add?
1. Yes
1. No
Name and Title
Phone
Phone Type
1. Business
2. Home
3. Mobile
Email Address
Continue

CERTIFICATIONS
Does your business or occupation require State of Georgia licensure?
1. Yes
1. No
Provide license number.
A copy of your state license must be attached to the application packet.
BUSINESS INFORMATION
Date Business Started
Date Business Started
Company Type
Sole Proprietor, LLC, Corporation, etc.
Federal Employee Identification Number or Social Security Number if Sole Proprietor
Georgia Sales and Use Tax Number
If applicable
NAICS Code (Six Digit Number)
Look up your NAICS code by business type.
Number of Employees
E-Verify Number
Business Description
I certify that the information submitted is true and correct.

_______________________________________________________________________________
Signature of Applicant
_______________________________________________________________________________
Title
_______________________________________________________________________________
Date
OFFICE USE ONLY - PLEASE DO NOT FILL OUT
Reviewed by: _____________________________________________ Zoning: _____________________________________________
Permitted Use: ___________________ List Use: _____________________________________________
Other Reason for Allowing Occupancy Type: _____________________________________________
License #: _____________________________________________ Fee: ___________________
Payment: ___________________ Date: ___________________

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