OCCUPATIONAL LICENSE RENEWAL APPLICATION
AND INSTRUCTIONS
Thank you for doing business in the City of Chattahoochee Hills. Attached is an application to renew your Business Occupational License. The terms Occupational License and Business License may be used interchangeably throughout this document.
- Complete the Occupational License Renewal Application and fee worksheet, if applicable. Professional practitioners or home-based businesses may choose to pay a flat rate.
- After completing the application, please sign and date the penalties information sheet and complete the Affidavit Verifying Status for City Business License Application, and Private Employer Affidavit. (Please note that Occupational License will not be issued unless both Affidavits are completed.)
- Return the application, signed penalties information sheet,the Affidavit Verifying Status for City Business License Application, Private Employer Affidavit, a copy of business owner’s Driver’s License (call City Clerk for other forms of acceptable ID) and check or money order in the total amount dueto the City of Chattahoochee Hills. Make checks payable to City of Chattahoochee Hills. Applications may be mailed to or hand-delivered to:
ChattahoocheeHills City Hall
Attn: Business Licenses
6505 Rico Road
Chattahoochee Hills,GA30268
- License renewals are due before March 31, 2012. Licenses are delinquent on April 1, 2012.
For questions, please call 770-463-8881.
2012OCCUPATION LICENSE RENEWAL APPLICATION
BUSINESS INFORMATION:
Business Name:
(DBA if applicable)
Business Address:
Business Mailing Address:
(If different than above)
Business Phone: Fax: Fed EIN:
No. of Employees: Business Commencement Date: //
OWNER/ LICENSEE INFORMATION:
Name:
(Corporate Name or Individual)
Email Address: Applicant’s Date of Birth: //
Driver License # DriverLicenseState Social Security #
TYPE OF OWNERSHIP:
[ ] Sole Proprietor[ ] Corporation[ ] Non Profit[ ] Partnership[ ] LLC
LOCATION:
[ ] Restaurant
[ ] Retail
[ ] Liquor Store
[ ] Home Based
[ ] Supermarket
[ ] Professional Practitioner (as defined by State Statute)
[ ] Service Station
[ ] Hotel/Motel/Inn/B & B
[ ] Other:
If you operate as a corporation, please complete information below:
TITLENAMEHOME ADDRESSCITY/ST/ZIP
President:
Vice President:
Secretary:
Treasurer:
Renewal Worksheet for Business Occupational Tax Certificate
Business Name:
NAICS Code: Fee Class: Rate:
Tax Adjustment for previous year: 2011
- Actual gross receipts for current year(A) $
Less allowable deductions
- Sales, Use or Excise taxes(a) $
- Inter-organizational sales(b)
- Payments to sub-contractors
(Provide name, address, phone# and dollar amount for each)(c)
- Out-of-State sales(d)
- Sales returns and allowances(e)
- Total deductions (add a through e)(f)
- Subtract deductions (f) from Actual Gross Receipts (A)(B)
- Estimated Gross Receipts from Previous Year(from previous year’s application)
(If actual and estimated gross receipts are less than $20,000, skip line D and proceed to line E)(C)
- Gross Receipts Adjustment = B (+/-) C(D)
- Tax Adjustment = Line D x Rate (insert rate)(E) $
Tax Calculation for current year: 2012
- Estimated gross receipts for current year(1) $
Less allowable deductions
- Sales, Use or Excise taxes(a) $
- Inter-organizational sales(b)
- Payments to sub-contractors
(Provide name, address, phone# and dollar amount for each)(c)
- Out-of-State sales(d)
- Sales returns and allowances(e)
- Total deductions (add a through e)(f)
- Subtract deductions (f) from Estimated Gross Receipts (1)(2)
- Standard Deduction (3)$20,000.00
- Subtract line 3 from line 2
(Enter 0.00 if amount is negative)(4)
- Multiply line 4 by Rate (insert rate)(5)
- Administrative fee (6) $75.00
- Subtotal- add lines 5 and 6(7)
- Business Tax Adjustment Fee for previous year
(Line E from top section)(8)
- Total amount due(Line 7 (+/-) Line 8)(9) $
Return completed Worksheet and Renewal Application with payment.
CALCULATION IF NO GROSS RECEIPTS
If your business generates gross receipts at the location in the City of Chattahoochee Hills, you must pay based on the collection of gross receipts method.
If your business does not generate gross receipts at the location in the City of Chattahoochee Hills, you must pay a rate based on the number of employees performing work at the location in the City.
The number of employees shall be computed on a full-time position basis and a full-time position equivalent basis. For the purpose of the calculation, an employee who works forty (40) hours or more weekly shall be considered a full-time employee and the average weekly hours of employees who work less than forty (40) hours weekly shall be added and such sum shall be divided by forty (40) to produce full-time position equivalents.
Business Name:______
- License Fee___ $150_____
- Number of Employees
a. Full-Time Employees (40 hours or more/week)______
b. Part-Time Employees (less than 40 hours/week)______
c. Average Weekly Hours for Part-Time Employee ______
d. Multiply lines b and c for Total Part-Time Weekly Hours ______
e. Divide line d by Forty Hours for total Full-Time Equivalent______
f. Add line a and e______
g. Multiply line f by $7.00 for Employee Based License Fee______
- Administrative Fee ______$75_____
- Total Amount Due – Add Line 1, Line 2g and Line 3______
HOME BASED AND PROFESSIONAL PRACTIONER CALCULATION
SECTION 2:
You may apply for a flat-rate if you are operating as a Home Occupation or a Professional Practitioner as defined by the City’s Code of Ordinances and State Statues. Below are the definitions and requirements to qualify.
Home Occupation:
Home occupation businesses are businesses that operate out of the applicant’s primary address. As defined in the Code of Ordinances Chapter 11: Article 1: Section 2, “Home base business (limit of one employee) shall pay a flat rate fee.” Additionally, according to the City’s zoning ordinance, outdoor storage of material or equipment on the premises is prohibited. Some examples of home occupation businesses are sales representatives, seamstress, financial planner.
Professional Practitioners:
Chapter 11: Article 1: Section 9 in the Code of Ordinances defines Professional Practitioners as those engaged in the business of, “Law, medicine, osteopathy, chiropractic, podiatry dentistry, optometry applied psychology, veterinary, landscape, architecture, land surveying, massage therapy and physiotherapy, public accounting, embalming, funeral directing, civil mechanical, hydraulic and electrical engineering, architecture, marriage and family therapists, social workers, and professional counselors.”
Only professional practitioners may elect to pay a flat rate of ($400) four-hundred dollars or base their fee on estimated gross receipts. Please provide a copy of your state license with the renewal application.
If applying as a Home-based business or Professional Practitioner, please check the appropriate box below.
- Home-Based[ ] $175
- Professional Practitioner[ ] $400
FAILURE TO RENEW PENALTIES
The City of Chattahoochee Hills shall assess a penalty in the amount of ten percent (10%) of the amount owed for each calendar year of portion thereof for:
- Failure to pay occupation taxes and administrative fees when due;
- Failure to file an application by March 31st of any calendar year when the business or practitioner was in operation the preceding calendar year; and/or
- Failure to register and obtain an occupational tax certificate within thirty (30) days of the commencement of business.
Delinquent taxes and fees are subject to interest at a rate of 1.5 percent per month.
Issuance of a business occupational tax certificate is not to be considered as an approval of said business use and in no way confirms that said business meet the requirement of the City of Chattahoochee Hills Zoning Resolution or the conditions of zoning approval.
The applicant must apply separately for any zoning variances to the appropriate department. Any incidence of non-compliance relating to the above zoning requirement will subject the certificate holder to possible revocation of the certificate.
Printed NameDate
SignatureDate
Business Name
(Business name)
(Business address)
(Business address 2)
(City, State, Zip)
Affidavit Verifying Status for
City Business License Application
By executing this affidavit under oath, as an applicant for a Business License or Occupation Tax Certificate as referenced in O.C.G.A. § 50-36-1(e)(2), from the City of Chattahoochee Hills, Georgia Business License or Occupational Tax Certificate, the undersigned applicant verifies one of the following with respect to my application for a public benefit:
1)______I am a United States citizen
2)______I am a legal permanent resident of the United States
3)______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:
.
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 violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute.
Executed in (city), (state).
Signature of Applicant
Printed Name:
SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE
____DAY OF ______, 20___
Notary Public
My Commission Expires:
Private Employer Affidavit Pursuant to O.C.G.A. § 36-60-6(d)
By executing this affidavit under oath, as an applicant for an Occupational Tax Certificate as referenced in O.C.G.A. § 36-60-6(d), from the City of Chattahoochee Hills, Georgia, the undersigned applicant representing the private employer known as ______[printed name of private employer] verifies one of the following with respect to my application for the above mentioned document:
1. Fill out this section between January 1, 2012, and June 30, 2012.
(a) ______On January 1st of the below signed year the individual, firm, or corporation employed more than five
hundred (500) employees.
(b)______On January 1st of the below signed year the individual, firm, or corporation employed less than five
hundred (500) employees.
If the employer selected 1(a) please fill out Section 4 below.
2. Fill out this section between July 1, 2012, and June 30, 2013.
(a) ______On January 1st of the below signed year the individual, firm, or corporation employed more than one
hundred (100) employees.
(b)______On January 1st of the below signed year the individual, firm, or corporation employed less than one
hundred (100) employees.
If the employer selected 2(a) please fill out Section 4 below.
3. Fill out this section on or after July 1, 2013.
(a) ______On January 1st of the below signed year the individual, firm, or corporation employed more than ten (10)
employees.
(b)______On January 1st of the below signed year the individual, firm, or corporation employed less than ten (10)
employees.
If the employer selected 3(a) please fill out Section 4 below.
4. The employer has registered with and utilizes the federal work authorization program in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-90. The undersigned private employer also attests that its federal work authorization user identification number and date of authorization are as listed below:
______
Federal Work Authorization User Identification Number
______
Date of Authorization
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 allowed by such statute.
Executed on the ___ date of ______, 201___ in ______(city), ______(state)
______
Signature of Authorized Officer or Agent
______
Printed Name of and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE ____ DAY OF ______, 201___.
______
NOTARY PUBLIC
My Commission Expires: ______