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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: