Georgia > Statewide > Department Of Revenue > Alcohol And Tobacco Division
State Tax Registration Application CRF-002 - Georgia
| State Tax Registration Application Form. This is a Georgia form and can be used in Alcohol And Tobacco Division Department Of Revenue Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Form CRF-002 (Rev. 7/12) GEORGIA DEPARTMENT OF REVENUE REGISTRATION & LICENSING UNIT P. O. BOX 49512 ATLANTA, GEORGIA 30359-1512 Fax: 404-417-4317 OR 404-417-4318 NEED HELP? CALL 1 (877) 423-6711 Page 1 E-MAIL: ST-License@dor.ga.gov TSD-withholding-lic@dor.ga.gov Section 1 1. 2. 3. 4. 5. Reason for Submitting this Form State Tax Registration Application 6. Did your business: Yes Yes No Acquire all or part of another business? No Result from a change in legal structure ( for example, from individual proprietor to corporation, partnership to corporation , corporation to limited liability company, etc...)? Georgia Department of Revenue Refer to the instructions and check the applicable box(es) to indicate the reason(s) for this registration. New Registration Additional Registration Application for a Master Number Information Update Additional Location (Use only for Master Sales Tax Account) No Undergo a merger, consolidation, dissolution, or other restructuring? Yes 7. Provide prior business' state tax identification number if you answered yes to any of the above choices: 8. Check the applicable box(es) to indicate the types of tax(es) and service(s) requested for this registration. Those types with asterisks (**) require an additional application. Motor Fuel License** Limousine Alcohol License ** Alcohol License ** Sales and Use Lottery Retailer** Motor Carrier/IFTA Non-Resident Distribution Withholding Tax Tobacco License ** 911 Prepaid Wireless Amusement License ** Contractor Section 2 Entity Type Sole Proprietorship (Individual) Professional Association Limited Liability Partnership (check the appropriate box) Partnership Sub-S Corporation Corporation- State of Incorporation: Limited Liability Company County Government Incorporation Date: Multiple Member Estate Federal Agency Fiduciary State Agency Single Member Municipal Government Federal Employer Information Number 1. Business Legal Name (enter owner's name if sole proprietor) Business Street Address (DO NOT USE P.O. BOX) Business Telephone Number Section 3 Business Information Business Trade Name (DBA) City County Business Email State Zip Code + 4 Business Fax Number 2. Date of First Operation (mm/dd/yyyy): 4. List Business's Fiscal Year End: 3. List months of operation if busine ss is seasonal (mm-mm): 5. Identify Accounting Method: Accrual Cash If you want to have GADOR notices and other correspondence for a specific tax type mailed to an address other than the above business street address, please complete the following information. Use Form CRF-003 to list additional addresses. City County State Zip Code + 4 1. Business Mailing Address Section 4 Business Mailing Address (if different from Section 3 above) 2. Use this mailing address for the following tax type(s): Sales and Use Withholding Amusement City Alcohol Tobacco County Motor Fuel Distributor State 911 Prepaid Wireless Zip Code + 4 1. Business Mailing Address 2. Use this mailing address for the following tax type(s): Sales and Use Withholding Amusement Alcohol Tobacco Motor Fuel Distributor 911 Prepaid Wireless 1. Name Section 5 Business Ownership/Relationship Social Security Number / Taxpayer Identification Number County State Zip Code + 4 Mailing Address Check one: Owner Alcohol Licensee LLC Member Effective Date: Partner City Officer Other Tobacco Licensee Effective Date: _______________ Effective Date : American LegalNet, Inc. www.FormsWorkFlow.com Check any/all if applicable: Form CRF-002 (Rev. 7/12) Page 2 1. Name Section 5 Business Ownership/Relationship (continued) Social Security Number / Taxpayer Identification Number City Mailing Address Check one: Owner Alcohol Licensee LLC Member Effective Date: Partner County State Zip Code + 4 Officer Other Effective Date: _______________ Effective Date : Check any/all if applicable: Tobacco Licensee Section 6 Retail Business Activity Information 2. Will you be selling motor Service % fuel or gasoline? Yes No % Manufacturing Yes % No Wholesale % Construction % 1. Check business activity type. If you check two or more boxes, list approximate percentages of receipts. 3. Are you a common carrier? 4. Please describe products to be sold and/or taxable services to be provided: 5. Enter business' NAICS code number if known: Section 7 Employer Withholding Information Other: 1. Will your business have employees? Yes No If you answered Yes, please complete lines 2 through 5. Your Business Payroll Service 2. Who will be responsible for filing and remitting payroll taxes for your employees? Name: Withholding Tax Account Number: Yes No 3. If you checked payroll service or other in question 2 above, enter the name and withholding tax number of the entity reporting and paying these taxes: 4. Do you expect to withhold more than $200 per month? 5. What is the first date on which wages will be paid to employees? Section 8 Authorized Signature/Contact Information Under penalties of perjury, I declare that I have examined this State Tax Registration Application and to the best of my knowledge and belief, it is true, correct and complete. I understand that to willfully prepare or present a document that is fraudulent or false is a criminal misdemeanor under O.C.G.A. ยง 48 -1-6. Authorized Signature Print Name Print Third Party Preparer's Name (if any) Title Date (mm/dd/yyyy) Daytime Telephone Number Daytime Telephone Number Title Title American LegalNet, Inc. www.FormsWorkFlow.com Form CRF-002 (Rev. 7/12) Page 3 Responsible Party Information Step 1 Read this information first Under section 48-2-52 of the Official Code of Georgia Annotated, a: corporation officer or employee, limited liability company member, manager or employee, or limited liability partnership, partner or employee may be held personally liable for unpaid sales tax, withholding tax, and 911 charges on prepaid wireless services assessed against such corporation, limited liability company, or limited liability partnership. The responsible party information be completed for each of the persons described above who is under a duty to collect, account for and pay any of the above-described taxes or amounts to the Department of Revenue. The responsible party information Attach additional pages if needed. also be used to notify the Department of Revenue when there is a change in responsible persons. Business Name Step 2 Identify the business registered or to be registered for any of the tax types or charges listed in Step 1 Business Address Title Federal Employer Identificati
|
|||||||
