Licenses and Permits Ocupation Tax Return (Business License – Non Alcoholic) Step 1 of 2 50% 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 BusinessAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneDate Started MM slash DD slash YYYY Location of BusinessDESCRIBE 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: QuantitySub TotalNext 10 Employees Price: QuantityPlease enter a number from 0 to 10.Sub TotalNext 10 Employees Price: QuantityPlease enter a number from 0 to 10.Sub TotalNext 10 Employees Price: QuantityPlease enter a number from 0 to 10.Sub TotalNext 10 Employees Price: QuantityPlease enter a number from 0 to 10.Sub TotalRemaining Employees Price: QuantityPlease enter a number from 0 to 1000.Sub TotalA 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. 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 ApplicantPrinted Name of ApplicantSUBSCRIBED AND SWORN BEFORE ME ON THIS ____DAY OF _________, 20___ ___________________ NOTARY PUBLIC My Commission Expires:
