Occupation tax return

Date: ______________ Phone: _____________

Name of business: _____________________________________________________

Mailing address: ______________________________________________________

___________________________________________________________________

Location of business: __________________________________________________

Date started: ______________________

Describe principal type of business conducted:_________________________________

Occupation Tax (business license)

Based on the number of employees (An employee is defined as any individual 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 for IRS W-2 but not a form IRS 1099. The city may request supporting information such as wage and tax reports to determine the accuracy of information.)

0-1 employees ________

2-5 employees ________

6-10 employees ________

11-50 employees _______

51-100 employees ______

101-200 employees _____

Over 200 employees _____

I hereby certify that the information reported herein is true and correct.

____________________________________________

(Signature of authorized person reporting)

_____________________________________________

(Printed name of authorized person reporting)

_____________________________________________

(Title of authorized person reporting)

This form must be completed and returned to the City Clerk’s office by Nov. 30 of the current year, P.O. Box 89, LaFayette, GA, 30728. Upon receipt of this completed form, you will be mailed an invoice with amount due.

Return to Administration.