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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 5/20/2015
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CRF-003 (Rev. 06/16/15) GEORGIA DEPARTMENT OF REVENUE REGISTRATION & LICENSING UNIT P. O. BOX 49512 ATLANTA, GA 30359-1512 1-877-GADOR11 (1-877-423-6711) ST-License@dor.ga.gov ADDITIONAL ADDRESS FORM (Complete Only If Necessary) (PLEASE PRINT OR TYPE) LEGAL BUSINESS NAME: ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales and Use Withholding Amusement Alcohol Tobacco Fireworks Excise Motor Fuel Distributor State Hotel-Motel Fee 911 Prepaid Wireless ADDRESSEE (C/O) (If different from or in addition to the Legal Busines Name) NUMBER AND STREET (P.O. BOX, RFD NO.) CITY STATE ZIP COUNTY E-MAIL ADDRESS FAX NUMBER PHONE NUMBER Fireworks Excise Motor Fuel Distributor State Hotel-Motel Fee 911 Prepaid Wireless ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales and Use Withholding Amusement Alcohol Tobacco ADDRESSEE (C/O) (If different from or in addition to the Legal Busines Name) NUMBER AND STREET (P.O. BOX, RFD NO.) CITY STATE ZIP COUNTY E-MAIL ADDRESS FAX NUMBER PHONE NUMBER Fireworks Excise Motor Fuel Distributor State Hotel-Motel Fee 911 Prepaid Wireless ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales and Use Withholding Amusement Alcohol Tobacco ADDRESSEE (C/O) (If different from or in addition to the Legal Busines Name) NUMBER AND STREET (P.O. BOX, RFD NO.) CITY STATE ZIP COUNTY E-MAIL ADDRESS FAX NUMBER PHONE NUMBER Fireworks Excise Motor Fuel Distributor State Hotel-Motel Fee 911 Prepaid Wireless ADDITIONAL MAILING ADDRESS (Please identify tax type(s) to be mailed to the address below.) Sales and Use Withholding Amusement Alcohol Tobacco ADDRESSEE (C/O) (If different from or in addition to the Legal Busines Name) NUMBER AND STREET (P.O. BOX, RFD NO.) CITY STATE ZIP COUNTY E-MAIL ADDRESS FAX NUMBER PHONE NUMBER SIGNATURE SECTION I HAVE EXAMINED THIS FORM, AND TO THE BEST OF MY KNOWLEDGE IT IS TRUE AND CORRECT. SIGNATURE TITLE DATE (MUST BE SIGNED BY OWNER, PARTNER, OR CORPORATE OFFICER AS LISTED IN THE RELATIONSHIP SECTION ABOVE.) American LegalNet, Inc. www.FormsWorkFlow.com
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