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Page 1 of 2 Greene County Occupational Tax Return 1034 Silver Drive, Suite 201 Greensboro, GA 30642 Phone [PHONE REDACTED] Renewal New Business Out of Business Date **All applications must be filled out completely. Incomplete forms will not be processed. COMPANY INFORMATION Business Name (including DBA name) Owner’s Name Email address Phone ( ) - Business Home Mobile Fax Other Phone/Fax ( ) - Business Home Mobile Fax Business Address City State Zip Mailing Address (if different) City State Zip SUB-CONTACTS (if different from owner and may include operator/manager/etc) Name(s) Phone ( ) - Business Home Mobile Fax Email address CERTIFICATIONS Does your business or occupation require State of Georgia licensure? If yes, provide license number here & attach copy of your State license: Turn over for page 2 of application ---PAGE BREAK--- Page 2 of 2 Greene County Occupational Tax Return 1034 Silver Drive, Suite 201 Greensboro, GA 30642 Phone [PHONE REDACTED] Page 2 BUSINESS INFORMATION Company Type (sole proprietor, LLC, Corporation, etc) Federal Employer Identification Number or Social Security Number Georgia Sales and Use Tax Number (if applicable) Date Business Started (new applications only) NAICS Code (six-digit number) You can look it up here by business type: example- 236115 (single- family house construction by general contractors) Business Description Number of Employees I certify that the information submitted is true and correct. Signature of Applicant Title Date Office Use Only – Please do not fill out Reviewed by: Zoning: Permitted use? List Other reason for allowing occupancy License# Fee Payment Date