Form Crf-002 - State Tax Registration Application - Georgia Department Of Revenue - 2002
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2CRF-002 (rev. 9/02)
GEORGIA DEPARTMENT OF REVENUE
REGISTRATION UNIT
P. O. BOX 49512
ATLANTA, GEORGIA 30359-1512
NEED HELP? CALL (404) 417-4490
(PLEASE PRINT OR TYPE)
STATE TAX REGISTRATION APPLICATION
(Please Read Instructions Before Completing)
IDENTIFICATION SECTION
1
IF YOU HAVE A STATE TAXPAYER IDENTIFIER (STI), ENTER HERE:
2
REASON FOR APPLICATION
Change in Location Address
Change in Alcohol Licensee
Change in Ownership Structure
Additional Tax Registration
New Business
Divided Store (Alcohol Only – Separate Applications required.)
New Location for a Master Sales Tax Account
Master Sales Tax Number :
3
FOR WHICH OF THE FOLLOWING ARE YOU APPLYING?
Use Tax Only
Alcohol License *
Motor Fuel Distributor *
Sales Tax
IFTA Registration *
Motor Fuel Tanker Truck Permit *
Withholding Tax
Amusement Machine *
Non-Resd. Distribution
Tobacco License
Application with an asterisk (*) require an additional application – See instructions for details
If your business is a Sole Proprietorship – Your Name is the Legal Business Name
4
LEGAL BUSINESS NAME
5
TRADE NAME / DBA NAME
6
TYPE OF OWNERSHIP
Sole Proprietorship
County Government
State Agency
Estate
Partnership
Municipality
Federal Agency
Fiduciary
Subchapter S Corp.
Professional Association
LLC
/
/
Corporation
-
State of Inc.
Date of Incorporation
7
IF THE BUSINESS LISTED ABOVE HAS AN “FEI” NUMBER, ENTER HERE:
8
IF SEASONAL BUSINESS, STATE MONTHS BUSINESS WILL BE OPEN:
Begin
Thru
9
WHAT IS THE LAST MONTH AND DAY OF YOUR ACCOUNTING YEAR:
Month
Day
IF THIS APPLICATION IS FOR A BUSINESS YOU PURCHASED, PROVIDE THE FOLLOWING INFORMATION REGARDING THE
10
FORMER OWNER, IF KNOWN.
LEGAL BUSINESS NAME
STI NO.
GA. SALES TAX NO.
GA. WITHHOLDING TAX NO.
PURCHASE PRICE OF BUSINESS
$
ADDRESS SECTION
LOCATION ADDRESS, NUMBER AND STREET SUITE/APARTMENT NUMBER (Enter physical location address of business.
(You CANNOT use a Post Office Box for the location address!)
11
CITY
STATE
ZIP
COUNTY
COUNTRY
PHONE
12
IS THE ABOVE ADDRESS LOCATED WITHIN THE CITY LIMITS?
Yes
No
NOTE:
To have correspondence and reporting forms sent to separate addresses, please complete Lines 13 and 14 and indicate the
related tax type(s) for each. To list additional mailing addresses use Form CRF-003.
13
MAILING ADDRESS – IF DIFFERENT FROM THE LOCATION ADDRESS ON LINE 11 ABOVE.
(Please identify tax type(s) to be mailed to the address below.)
A
Sales and Use
Withholding
Alcohol
Tobacco
Motor Carrier / Tanker Truck
Motor Fuel Distributor
B
ADDRESSEE
(c/o) (If different from or in addition to the Legal Business Name)
C
NUMBER AND STREET, P. O. BOX or RFD NO.
D
CITY
STATE
ZIP
COUNTY
COUNTRY
PHONE
14
ADDITIONAL MAILING ADDRESS – (Please identify tax type(s) to be mailed to the address below.)
A
Sales and Use
Withholding
Alcohol
Tobacco
Motor Carrier / Tanker Truck
Motor Fuel Distributor
B
ADDRESSEE
(c/o) (If different from or in addition to the Legal Business Name)
C
NUMBER AND STREET, P. O. BOX or RFD NO.
D
CITY
STATE
ZIP
COUNTY
COUNTRY
PHONE
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