2021 Business License Application

For a PDF of the License Click Here

50 River Street
Hiawassee, GA 30546
Phone (706) 896-2202 Fax (706) 896-4991

2021 Business License Application

Instructions: a. Please Complete this form completely.

Make check payable to “City of Hiawassee” for the amount shown below.
Place return both completed forms & payment to the address above.

TYPE OF LICENSE (Select One Below):

___New Business ($100.00) ___Renewal ($100.00)

____Address Change (FREE) (Notification -5 days from move to new location)

FEE DUE DATE: Please submit payment by December 15^th, 2021.

After January 1, 2022 -$125.00. Subject to closure and additional penalty after 2/1/2022

______________________________________________________________________________

Name of Business_____________________________________________________________

Business Physical Addess_____________________________________________________

Business Telephone Number____________________________Fax#___________________

Email Address:

____________________________________________________________________________

Business Website:___________________________________________________________

This Information will appear on the City Website at no Charge

Please check here if you wish to opt out of appearing ______

______________________________________________________________________________

Name of Applicant: _________________________________________________________________

Applicant Phone Telephone #: __________________ (Home) ______________________ (Cell)

Business Mailing Address (If different): __________________________________________________

Emergency Contact Name & Number (24hr): ___________________________________________

Please provide a brief description of business activities (Business Type): (

Please list most description you would like to have on website first.

For example, if your business sells furniture, but also sells clothing, which category would you prefer to have your business listed under)

__________________________________________________________________________________

Years in Business: ______________________

Number of employees: Full- time _______ Part-time_______

Will any activities involve the use of chemicals, machinery or matter of energy that may create or cause to be created, noise, noxious odors or hazards that will endanger the health, safety or welfare of the community? ¨ Yes____ ¨ No____

Do you own or lease the business location?¨Own_____ ¨Rent/Lease____

Do you require a State License Under O.C.G.A § 43- Professions & Businesses, if yes, please provide a copy of your professional license?¨ Yes_____ ¨ No_____

Please provide your Federal Tax Id No.: ______________________

Will this business be based out of your home? ¨ Yes____ ¨ No____

Is this a VRBO/AirBnB/Rental Property type business? ¨ Yes____ ¨ No____

Notice

If you plan to place a sign on your business, The City of Hiawassee requires a sign permit. Please contact the City of Hiawassee at (706) 896-2202 regarding the number, size, and type of signage that is allowed for your business location, in addition to obtaining a Sign Permit Application.

The City of Hiawassee requires a Building Permit if any construction or remodels (i.e. plumbing, additions, electrical) are to take place at the business location. Please contact the City of Hiawassee at (706) 896-2202 regarding the type of construction that requires a permit.

I,_______________________________, do solemnly swear that the information on this application is true, correct to the best of the applicant’s knowledge, training, and ability, and that no false or misleading statement is made herein to obtain a Business Occupational Tax Certificate. I understand that if I provide false or misleading information in this application, I may be subject to criminal prosecution and /or immediate revocation of my Business Occupational Tax Certificate issued as a result of this application. I understand that I must comply with all City of Hiawassee ordinances and regulations. All tax certificates expire December 31 of the current year and must be renewed annually.

Applicant Signature____________________________ Date________________________

Print Name: ______________________________ Title______________________

Private Employer Affidavit Pursuant to O.C.G.A. § 36-60-6(d)

By executing this affidavit under oath, the undersigned private employer verifies one of the following with respect to its application for a business license, occupational tax certificate, or other document required to operate a business as referenced in O.C.G.A. § 36-60-6(d):

Section 1. Select an option below

____¨On January 1st of the below-signed year, the individual, firm, or

corporation employed more than ten (10) employees.

*** If you select Section 1(A), please fill out Section 2 and then execute below.

_____¨On January 1st of the below-signed year, the individual, firm, or corporation

employed ten (10) or fewer employees.

*** If you select Section 1(B), please skip Section 2 and execute below.

Section 2. (If the Employer selected (A) above please fill out this section.)

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. § 36-60-6. The undersigned private employer also attests that its federal work authorization user identification number and date of authorization are as follows:

________________________________________________________________________________________

Name of Private Employer

________________________________________________________________________________________

Federal Work Authorization User Identification Number

________________________________________________________________________________________

I hereby declare under penalty of perjury that the foregoing is true and correct.

______________________________________________ Date: _______________________

Signature of Authorized Officer or Agent or Employer

_______________________________________

Printed Name and Title of Authorized Officer or Agent

Date of Authorization

O.C.G. A. § 50-36-1(e)(2) AFFIDAVIT

By executing this affidavit under oath, as an applicant for a loan, grant, tax credit and/or other public benefit, as referenced in O.C.G.A. § 50-36-1, administered by the Georgia Department of Community Affairs, the undersigned applicant verifies one of the following with respect to my application for a public benefit:

I am a United States

I am a legal permanent resident of the United

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

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:

(For a list of acceptable documents, please go our website “Hiawasseega.gov”)

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 as allowed by such criminal statute.

Executed this the day of , 20_ in __(city), (state).

*Signature of Applicant

Printed Name of Applicant

Subscribed And Sworn Before Me On This

______Day Of _________________, 202____.

_______________________________________

NOTARY PUBLIC

My Commission Expires:

*This Affidavit must be signed by the same person who executes the Application Certification Form Letter