Form Crf-002 - State Tax Registration Application
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CRF-002
(Rev. 2/13)
Form
GEORGIA DEPARTMENT OF REVENUE
REGISTRATION & LICENSING UNIT
P. O. BOX 49512
ATLANTA, GEORGIA 30359-1512
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E-MAIL:
ST-License@dor.ga.gov
Georgia Department of Revenue
TSD-withholding-lic@dor.ga.gov
State Tax Registration Application
Section 1
Reason for Submitting this Form
Refer to the instructions and check the applicable box(es) to indicate the reason(s) for this registration.
1.
New Registration
6. Did your business:
Yes
No Acquire all or part of another business?
2.
Additional Registration
Yes
No Result from a change in legal structure ( for example, from individual proprietor to
3.
Application for a Master Number
corporation, partnership to corporation , corporation to limited liability company,
4.
Information Update
etc…)?
No Undergo a merger, consolidation, dissolution, or other restructuring?
Yes
5.
Additional Location
(
Master Sales Tax Account)
Use only for
7. P ro vide prior business' state tax identification number if you answered yes to any of the above
choices:
8. Check the applicable box(es) to indicate the types of tax(es) and service(s) requested for this registration. Those types with as terisks (**)
require an additional application.
Limousine Alcohol License **
Motor Fuel License **
Sales and Use
Alcohol License **
Lottery Retailer**
Non -Resident Distribution
Motor Carrier/IFTA
Tobacco License **
Withholding Tax
Contractor
911 Prepaid Wireless
Amusement License **
Section 2
Entity Type
(check the appropriate box)
Partnership
Sole Proprietorship
Sub-S Corporation
Corporation- State of Incorporation:
Incorporation Date:
(Individual)
Estate
Single Member
Multiple Member
Professional Association
Fiduciary
Limited Liability Company
Federal Agency
County Government
Municipal Government
Limited Liability Partnership
State Agency
S ection 3
Business Information
Business Trade Name (DBA)
Federal Employer Information Number
1.
Business Legal Name
(enter owner's name if sole proprietor)
County
State
Zip Code + 4
Business Street Address (DO NOT USE P.O. BOX)
City
Business Fax Number
Business Email
Business Telephone Number
2.
Date of First Operation (mm/dd/yyyy):
3.
List months of operation if busine ss is seasonal (mm-mm):
4.
List Business's Fiscal Year End:
5.
Identify Accounting Method:
Accrual
Cash
Section 4
Business Mailing Address
(if different from Section 3 above)
If you want to have GADOR notices and other correspondence for a specific tax type mailed to an address other than the above business
street address, please complete the following information. Use Form CRF -003 to list additional addresses.
City
County
State
Zip Code + 4
1.
Business Mailing Address
2.
Use this mailing address for the following tax type(s):
911 Prepaid Wireless
Sales and Use
Withholding
Amusement
Alcohol
Tobacco
Motor Fuel Distributor
City
County
State
Zip Code + 4
1.
Business Mailing Address
2.
Use this mailing address for the following tax type(s):
911 Prepaid Wireless
Sales and Use
Withholding
Amusement
Alcohol
Tobacco
Motor Fuel Distributor
Section 5
Business Ownership/Relationship
Social Security Number / Taxpayer Identification Number
1.
Name
State
Mailing Address
City
County
Zip Code + 4
Check one:
Partner
Officer
Owner
Other
Effective Date: _______________
LLC Member
Check any/all if applicable:
Alcohol Licensee
Tobacco Licensee
Effective Date :
Effective Date:
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