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Coin Operated Amusement Machine Location List ATT-301 - Georgia
| Coin Operated Amusement Machine Location List Form. This is a Georgia form and can be used in Alcohol And Tobacco Division Department Of Revenue Statewide . |
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ATT-301 (Rev. 4/12) Georgia Department of Revenue ATD-COAM P.O. Box 105458 Atlanta, Georgia 30348-5458 (404) 417-4900 ATDIV@dor.ga.gov Page ______ of ______ STATE TAXPAYER ID NUMBER ___________________ MASTER LICENSE NUMBER _____________________ Please type or print legible. All information below must be complete. Any incomplete information will result in the rejection of the COAM application. This form is required for all COAM class A and B Master License Applications and Renewals. COIN OPERATED AMUSEMENT MACHINE LOCATION LIST LOCATION LEGAL BUSINESS NAME LOCATION TRADE NAME LOCATION ADDRESS CITY, ZIP CODE NUMBER OF NUMBER OF CLASS B CLASS A MACHINES MACHINES If additional pages are required, please use a blank copy of this form. American LegalNet, Inc. www.FormsWorkFlow.com
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