Licenses and Permits

Ocupation Tax Return (Business License – Alcohol)

NEW APPLICANTS (COMPLETE THE FOLLOWING):

APPLICATIONS (2)
SALE OF MALT BEVERAGE
ON/OFF PREMISES FORM
CONSENT FORM
PRIVACY RIGHTS/PRIVACY ACT STATEMENT
CITIZENSHIP AFFIDAVIT (ATTACH COPY OF DRIVER LICENSE TO FORM) (FORM HAS TO BE NOTARIZED)
PAY ALL REQUIRED BUSINESS LICENSE FEES TO THE CITY OF BUENA VISTA:
$50.00 (FINGERPRINTS)
COST OF EMPLOYEES/BASIC FEE OF LICENSE
SALE OF ALCOHOL
PLACE ADVERTISEMENT IN LOCAL NEWSPAPER (2) WEEKS
(RICHARD HARRIS) 229-649-6397
APPLICANT WILL COME BEFORE CITY COUNCIL (CITY CLERK WILL SCHEDULE DATE)

RETURNING APPLICANTS (ANNUAL RENEWAL):

APPLICATION
SALE OF MALT BEVERAGE ON/OFF PREMISES FORM
CONSENT FORM
PRIVACY RIGHTS/PRIVACY ACT STATEMENT
PAY ALL REQUIRED BUSINESS LICENSE FEES TO THE CITY OF BUENA VISTA:
$50.00 (FINGERPRINTS)
COST OF EMPLOYEES/BASIC FEE OF LICENSE
SALE OF ALCOHOL

*BUSINESS LICENSES WILL BE PROCESSED WITHIN THREE BUSINESS DAYS.

THANK YOU,

CITY CLERK’S OFFICE

Step 1 of 5

20%

CITY OF BUENA VISTA
P.O. BOX 158
BUENA VISTA, GA 31803
229-649-7888
OCCUPATION TAX RETURN (BUSINESS LICENSE)

Date

MM slash DD slash YYYY

Name of Business

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number

Date Started

MM slash DD slash YYYY

Location of Business

DESCRIBE PRINCIPLE TYPE OF BUSINESS CONDUCTED:

THE TERM "EMPLOYEES" SHALL MEAN INDIVIDUALS WHOSE WORK IS PERFORMED UNDER THE DIRECTION AND SUPERVISION OF THE EMPLOYER AND WHOSE EMPLOYER WITHHOLDS FICA, FEDERAL INCOME TAX, OR STATE INCOME TAX FROM SUCH INDIVIDUAL'S COMPENSATION OR WHOSE EMPLOYER ISSUES TO SUCH INDIVIDUAL FOR PURPOSES OF DOCUMENTING COMPENSATION A FORM IRS W-2 BUT NOT A FORM IRS 1099.

First 10 Employees

Price:

Quantity

Sub Total

Next 10 Employees

Price:

Quantity

Please enter a number from 0 to 10.

Sub Total

Next 10 Employees

Price:

Quantity

Please enter a number from 0 to 10.

Sub Total

Next 10 Employees

Price:

Quantity

Please enter a number from 0 to 10.

Sub Total

Next 10 Employees

Price:

Quantity

Please enter a number from 0 to 10.

Sub Total

Remaining Employees

Price:

Quantity

Please enter a number from 0 to 1000.

Sub Total

A MINIMUM TAX OF $50.00 SHALL BE APPLIED TO ALL BUSINESSES.

YOUR OCCUPATION TAX TOTAL (LINE A + B) IS:

LINE A:

+

LINE B:

Total Occupation Tax::

I HEREBY CERTIFY THAT THE INFORMATION REPORTED HEREIN IS TRUE AND CORRECT.

SIGNATURE OF AUTHORIZED PERSON REPORTING(Required)

PLEASE NOTE THAT PRACTITIONERS OF CERTAIN PROFESSIONS MAY CHOOSE TO PAY A FLAT FEE OF $200.00 PER PRACTITIONER. IF YOU ARE CONSIDERING THIS OPTION, PLEASE CONTACT THE CITY CLERK. PLEASE RETURN COMPLETED FORM WITH PAYMENT TO THE CITY CLERK'S OFFICE.

APPLICATION TO SELL ALCOHOLIC BEVERAGES IN THE CITY OF BUENA VISTA

Type of Application:

Restaurant

Bar

Night Club

Convenient Store

Grocery Store

Package Store

Other

Type of License applied for:

Package Distilled Spirits

Package Beer/Malt Beverage

Package Wine

On-Premises Distilled Spirits

On-Premises Beer/Malt Beverage

On-Premise Wine

1. Business Title:

Legal name of business

Business location

Businesss telephone number

2. Applicant:

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Date of birth

Month

Day

Year

U.S. Citizen

Yes

How long have you been a citizen?

Home telephone number

What is the applicant's relationship to the business?

Is this business operated as a partnership or corporation?

Yes

Please provide a list of all partners or board of directors and thier addresses.

Has the applicant, or any individual listed as having an interest in this business, ever been convicted, pleaded nolo contendere or forfeited bond for any of the disqualifying conditions listed in the City of Buena Vista’s Alcohol Beverage Ordinance?

Yes

Please Explain

Has the applicant applied for a GA sales tax number?

Yes

I (Applicant), being duly sworn according to the law, do swear that the facts stated in the above application are true and correct. I have read and understand, and also agree to abide by the City of Buena Vista Alcoholic Beverage Ordinance, and any State or Federal laws or regulations governing the sale of alcoholic beverages.

Name of Applicant

______________________________ Signature of Applicant

Sworn to and subscribed before me this ________day of ________________________.

Notary Public__________________________________ My commission expires________________________

CITY OF BUENA VISTA, GEORGIA

TO: RETAIL SELLERS OF ALCOHOLIC BEVERAGES IN THE CITY OF BUENA VISTA

ON JANUARY 1, 1995, A NEW GEORGIA LAW TOOK EFFECT WHICH CHANGED THE METHOD BY WHICH THE CITY FIGURES OCCUPATION TAXES; HOWEVER THIS LAW DID NOT AFFECT THE FEE FOR ALCOHOLIC BEVERAGE LICENSES.

Please Check:

SALE OF MALT BEVERAGE ON PREMISES ($225.00)

SALE OF MALT BEVERAGE OFF PREMISES ($175.00)

SALE OF ALCOHOL BY THE DRINK ($1,500.00)

LIQUOR STORE ($2,000.00)

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MaltOnPrem

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MaltOffPrem

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AlcoholByDrink

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LiquorStore

Total:

BUENA VISTA POLICE DEPARTMENT
P.O. BOX 384
136 EAST 6th AVENUE
BUENA VISTA, GEORGIA 31803
229-649-7888
229-649-2177
WENDELL FAULK (CHIEF OF POLICE)

CONSENT FORM

I hereby authorize __________________________ the following entity to receive any criminal history record information pertaining to me which may be the files of any state or local criminal justice agency in Georgia.

Authorized Entity

0.C.G.A. § 50-36-1 (E)(2) AFFIDAVIT

By executing this affidavit under oath, as an applicant for a BUSINESS LICENSE, as referenced in O.C.G.A. § 50-36-1 (e)(2), with the CITY OF BUENA VISTA, the undersigned applicant verifies one of the following with respect to my application for a public benefit:

Affidavit Requirements

I am a United States Citizen

I am a legal permanent resident of the United States

I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other Federal immigration agency.

My alien number issued by the Department of Homeland Security or other federal Immigration agency is:

The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1 (e)(1), with this affidavit.

The secure and verifiable document provided with this affidavit can best be classified as: (Valid Photo Id)

Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB.

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute.

Executed in BUENA VISTA, GEORGIA.

Signature of Applicant

Printed Name of Applicant

SUBSCRIBED AND SWORN
BEFORE ME ON THIS
____DAY OF _________, 20___

___________________
NOTARY PUBLIC
My Commission Expires:

Untitled

Licenses and Permits

Ocupation Tax Return (Business License – Alcohol)

NEW APPLICANTS (COMPLETE THE FOLLOWING):

RETURNING APPLICANTS (ANNUAL RENEWAL):

DESCRIBE PRINCIPLE TYPE OF BUSINESS CONDUCTED:

+

APPLICATION TO SELL ALCOHOLIC BEVERAGES IN THE CITY OF BUENA VISTA

1. Business Title:

2. Applicant:

CITY OF BUENA VISTA, GEORGIA

TO: RETAIL SELLERS OF ALCOHOLIC BEVERAGES IN THE CITY OF BUENA VISTA

ON JANUARY 1, 1995, A NEW GEORGIA LAW TOOK EFFECT WHICH CHANGED THE METHOD BY WHICH THE CITY FIGURES OCCUPATION TAXES; HOWEVER THIS LAW DID NOT AFFECT THE FEE FOR ALCOHOLIC BEVERAGE LICENSES.

BUENA VISTA POLICE DEPARTMENTP.O. BOX 384136 EAST 6th AVENUEBUENA VISTA, GEORGIA 31803229-649-7888229-649-2177WENDELL FAULK (CHIEF OF POLICE)

CONSENT FORM

0.C.G.A. § 50-36-1 (E)(2) AFFIDAVIT

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BUENA VISTA POLICE DEPARTMENT
P.O. BOX 384
136 EAST 6th AVENUE
BUENA VISTA, GEORGIA 31803
229-649-7888
229-649-2177
WENDELL FAULK (CHIEF OF POLICE)