2020 
OCCUPATION TAX GENERAL RENEWAL APPLICATION
WRECKER & TOWING SERVICE
50 E Main St · Statesboro, Georgia 30458   Phone (912) 764-5468
www.statesboroga.gov

Renewal Deadline: January 31st 

***IMPORTANT***
Please note that a renewal application form must be completed EACH YEAR even if all information remains the same. The Business License Division cannot process incomplete applications. If any item is missing, incomplete or incorrect, your application cannot be processed.  Incomplete renewal applications will result in delayed processing.  

ALL LINES MUST BE FILLED WITH THE REQUIRED INFORMATION OR N/A(IF NOT APPLICABLE)
PLEASE TYPE, OR PRINT                                                          IF YOUR BUSINESS HAS MOVED OR CHANGED OWNERS PLEASE CONTACT THE TAX OFFICE.
BUSINESS INFORMATION	
BUSINESS NAME:

D/B/A NAME:	CHANGE OF BUSINESS NAME: YES	NO	BUSINESS SOLD			
		BUSINESS CLOSED

DATE SOLD OR CLOSED:	
***A NEW BUSINESS APPLICATION AND ADDITIONAL INFORMATION IS REQUIRED IF BUSINESS ADDRESS HAS CHANGED***	
BUSINESS ADDRESS: (Do Not Use P O Box)

CITY / STATE / ZIP	MAILING ADDRESS: (If Different From Business Address)

CITY / STATE / ZIP	
BUSINESS TELEPHONE NUMBER:	HOME BASED BUSINESS:	YES	NO

TYPE OF BUSINESS:__________________________________	
OWNERSHIP STATUS:
Sole Owner	Partnership	LLC	INC	CO	FEDERAL TAX ID #:__________________________________ GA SALES TAX ID #:__________________________________	
OWNER’S / AGENT INFORMATION	
POSITION WITH BUSINESS:	OWNER	AGENT (Representative Of
Business)	EMAIL ADDRESS:	
OWNER’S / AGENT NAME: (First, MI, Last)	OWNER’S / AGENT HOME ADDRESS:	OWNER’S / AGENT TELEPHONE NUMBER:	
			
CALCULATE YOUR 2020 FEES

 __________ x  20.00 + 95.00 + 85.00  =	       $_                    Full time equivalent employees are determined by adding the total number
 
NO. EMPL	RATE               ADMIN FEE         REG FEE	TOTAL AMOUNT DUE          of hours worked by all employees per week and dividing by 40. Salaried employees, 
  10% Penalty for failure to renew by January 31st 	                                                       employees with overtime and owners should be counted as 40 hours per week.
 	
CERTIFICATION	

I (APPLICANT)	BEING THE (TITLE)  	
(PRINT NAME)	(EX; OWNER/PRESIDENT/MANAGER/AGENT)
OF THE BUSINESS FIRM NAMED, DO HEREBY REGISTER TO OPERATE SAID BUSINESS WITHIN THE CITY OF STATESBORO.

STATE OF GEORGIA PROFESSIONAL License #:_______________________________ If applicable, please include copies of all required State Licenses.

IN ACCORDANCE WITH THE BUSINESS ORDIANCE OF THE CITY OF STATESBORO, I, THE UNDERSIGNED,	DO NOT WRITE IN THIS SPACE. CERTIFY THAT I AM THE PERSON DULY AUTHORIZED BY THE BUSINESS HEREIN NAMED TO FILE THIS		OFFICE USE ONLY
RETURN, INCLUDING THE ACCOMPANYING SCHEDULES AND STATEMENTS AND THAT THE SAME ARE TRUE, CORRECT, AND COMPLETE. UPON ISSUANCE OF A BUSINESS LICENSE, IT SHALL BE MY RESPONSIBILITY TO RENEW THE LICENSE ANNUALLY BY JANUARY 31st.

APPLICANTS SIGNATURE	_______DATE______________  	

**Please list information for ALL drivers. ALL drivers will need to submit a background check**

Name:_________________________________________________________________
Address:_______________________________________________________________
______________________________________________________________________
Phone number:_________________________________________________________

Name:_________________________________________________________________
Address:_______________________________________________________________
______________________________________________________________________
Phone number:_________________________________________________________

Name:_________________________________________________________________
Address:_______________________________________________________________
______________________________________________________________________
Phone number:_________________________________________________________

Name:_________________________________________________________________
Address:_______________________________________________________________
______________________________________________________________________
Phone number:_________________________________________________________