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PICKENS COUNTY PLANNING & DEVELOPMNENT 1266 East Church Street, Suite 136 Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Business License Renewal Application Business License Number: Business Name: Owner Name: Nature of Business: Physical Address: City State Zip Mailing Address: City State Zip Phone Number: Email Address: E-VERIFY PRIVATE EMPLOYER REQUIREMENTS GEORGIA LAW, O.C.G.A. § 36-60-6, REQUIRES ALL BUSINESSES, WITH MORE THAN 10 EMPLOYEES THAT ARE SEEKING AN OCCUPATION TAX CERTIFICATE/BUSINESS LICENSE OR OTHER DOCUMENT REQUIRED TO OPERATE A BUSINESS WITH A COUNTY OR CITY TO SIGN AN AFFIDAVIT ATTESTING THAT THEY ARE REGISTERED FOR AND USE E-VERIFY. E-Verify Number Number of Employees: IF APPLICABLE: Secretary of State License Number: Expiration Date: Department of Agriculture License Number: Expiration Date: Food Service Permit current copy of the above licenses is required with this renewal form*** I hereby certify the information provided above is true and correct to the best of my knowledge Signed Date: FOR PLANNING & DEVELOPMENT USE ONLY Date Paid: Cash/Check/Card: Receipt#: Approved By: Renewal Year: ---PAGE BREAK--- Updated 9/16/2021 If your business has closed or moved outside of Pickens County and you do not need to renew your County business license, please fill out the information below and return to our office. Business Name: Owner Name: Phone Number: Date Business Closed &/or Moved: Reason for non-renewal: Signed Date: