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Dawson County Business License Renewal Form Business Information Business Name: Physical Address: Mailing Address (if different): Business Type: Business Phone: Email: Contact Person: Gross Annual Income Declaration Per Dawson County Ordinance Section 30-169, the business license fee is based on gross annual income. The IRS defines gross income as total sales and revenue minus the cost of goods sold (COGS), plus any additional income from investments or other sources. Please indicate your estimated gross income for the most recent fiscal year: Annual Gross Income Estimate Fee Amount (includes $50 admin fee) ☐Tier 1: $1 – $249,999 $250.00 ☐ Tier 2: $250,000 – $999,999 $650.00 ☐Tier 3: $1,000,000 - $2,499,999 $1050.00 ☐Tier 4: $2,500,000 and above $2050.00 Annual Estimated Gross Income: Certification I hereby certify that the gross income provided above is a true and accurate estimate to the best of my knowledge. I understand that falsification of this information may result I penalties, including revocation of the business license. Printed Name: Signature: Date: Payment Instructions: Please make checks payable to: Dawson County Government Mail or submit payment to: Dawson County Planning and Development 25 Justice Way, Suite 2322 Dawsonville, GA 30534