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Additional Address Form CRF-003 - Georgia

Additional Address Form Form. This is a Georgia form and can be used in Alcohol And Tobacco Division Department Of Revenue Statewide .
 Fillable pdf Last Modified 3/18/2010
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CRF-003 REV. 5/05 GEORGIA DEPARTMENT OF REVENUE REGISTRATION & LICENSING UNIT P. O. BOX 49512 ATLANTA, GA 30359-1512 404-417-4490 TSD-sales-tax-lic@dor.ga.gov ADDITIONAL ADDRESS FORM (Complete Only If Necessary) (PLEASE PRINT OR TYPE) FOR OFFICE USE ONLY LEGAL BUSINESS NAME: ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales & Use Tobacco Withholding Amusement on to the Legal Business Name) A lc ohol Motor Fuel Distributor E-MAIL ADDRESS ADDRESSEE (C/O) (If di erent from or in additi N U MB E R A N D S T R E E T , P . O . B O X , R F D N O . CITY STATE ZIP COUNTY F A X N U MB E R () COUNTRY PHONE NUMBER () ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales & Use Tobacco Withholding Amusement on to the Legal Business Name) A lc ohol Motor Fuel Distributor E-MAIL ADDRESS F A X N U MB E R () C O UNT R Y P H O N E N U MB E R () ADDRESSEE (C/O) (If di erent from or in additi N U MB E R A N D S T R E E T , P . O . B O X , R F D N O . C IT Y S T AT E Z IP C O UNT Y ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales & Use Tobacco ADDRESSEE (C/O) (If di erent from or NUMBER AND STREET, P. O. BOX, RFD NO. CITY STATE ZIP Withholding Amusement in addition to the Legal Business Name) A lc ohol Motor Fuel Distributor COUNTY COUNTRY PHONE NUMBER () ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales & Use Tobacco Withholding Amusement on to the Legal Business Name) A lc ohol Motor Fuel Distributor E-MAIL ADDRESS ADDRESSEE (C/O) (If di erent from or in additi N U MB E R A N D S T R E E T , P . O . B O X , R F D N O . CITY STATE ZIP COUNTY F A X N U MB E R () COUNTRY PHONE NUMBER ( ) SIGNATURE SECTION I HAVE EXAMINED THIS FORM, AND TO THE BEST OF MY KNOWLEDGE IT IS TRUE AND CORRECT. Signature (MUST BE SIGNED BY OWNER, PARTNER, OR CORPORATE O Title FFICER AS LISTED IN THE RELATIONSHIP SECTION ABOVE.) Date American LegalNet, Inc. www.FormsWorkflow.com
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