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2. Occupational Tax Certificate Application
   Complete this form for new business applications and for renewals of businesses that have changed their name, owner, location, or State license holder. This application must be completed for all businesses operating in Lumpkin County. You may wish to review the application so you can gather all of the necessary forms and documentation that are required to be submitted with the application.
4. If you have any questions while completing the form, please contact the Planning Department at 706-864-6894.
6. Is the business in operation?
   -- Select One --YesNo
7. If yes, give the date business started:
8. If no, provide planned start date:
10. Business Name
12. DBA (Doing Business As)
14. Business Location (must be a physical location, not a PO Box)
16. Business Mailing Address
18. City
19. State
20. Zip Code
22. Business Phone Number
23. Business Fax Number
25. Email Address (if you have one)
27. Is the building owned or leased?
    -- Select One --OwnedLeased
28. Owner/Landlord:
30. Is the property under a Conservation Use Value Assessment (CUVA)?

    (IF YES, PLEASE CONTACT THE TAX ASSESSORS FOR APPROVAL AT 706-864-2433)

31. (Initial one)*

    1. Yes
    2. No
35. Type of Ownership
    -- Select One --Sole ProprietorshipPartnershipCorporationOther
36. If other, please describe:
38. Business Owner
39. Phone Number
41. Home Address
43. City
44. State
45. Zip Code
47. DOB
48. Last 4 of SS#
50. Additional Owners Document
    If there are additional owners, please upload a document with the information.
51. Photo ID
    Please upload a photo ID.
53. Federal Employer ID#
54. Georgia Sales Tax #
56. State License #
57. Name on License
59. Expiration Date:
60. Health Department Number
62. Primary Business Activity
64. Will Vehicles of Equipment be stored on site?
    -- Select One --YesNo
65. Will there be an outdoor display?
    -- Select One --YesNo
67. If yes, please list products and/or equipment to be stored or displayed:

69. Please upload a copy of any State or Federal License required for the operation of your business. Also, any business required to obtain health permits, bonds, certificates of qualification, certificates of competency, or any other regulatory matter must show evidence that such requirements have been met by including a copy of such with the application. You will also need to upload the following forms: Private Employer Affidavit and Affidavit Verifying Status For County Public Benefit Application. (These forms can be found on the Planning Department website page and are required to be notarized.)

71. Document 1
72. Document 2
73. Document 3
75. Document 4
76. Document 5
77. Document 6
79. Document 7
80. Document 8
81. Document 9
83. Document 10

85. Licenses are issued for a calendar year, January through December. Payment must accompany the application. You can pay upon completion and submission of this form with a debit or credit card, or print and submit with a check or money order made payable to Lumpkin County Planning Department. Applications and payments may be mailed to: Lumpkin County Planning 342 Courthouse Hill, Suite A, Dahlonega, GA 30533 Cash is not accepted for this license. Notices will be mailed out in November of each year for the following calendar year. The occupation tax shall be due and payable annually on or before November 15 each year. In the event that any person commences a new business on any date after January 1, the occupation tax shall be due and payable 30 days following the commencement of the business. Penalties are charged on any payments made after January 1. We do not accept postmarks. Each application is stamped with a received date when it is delivered. This is the date we use for determining the timeliness of payment, not the postmark.

87. Incomplete applications, applications submitted without property payment or required documentation or licensing will be returned. Incomplete applications will not be processed.
89. After registration with Lumpkin County, and upon payment of the applicable occupation tax, an Occupation Tax Certificate shall be issued by the Planning Department. The Occupation Tax Certificate shall be displayed in a conspicuous location in the place of business if the taxpayer has a permanent business location in Lumpkin County, Georgia. If the taxpayer has no permanent location in Lumpkin County, Georgia, the Occupation Tax Certificate shall be shown to any agent of Lumpkin County upon request.
93. Tax Computation
95. 1. Enter total number of full time employees.
96. 2. Enter total number of full time equivalents.
    To calculate the number of full-time equivalent employees, add the total hours of the part-time employees and divide by 40 hours.
98. General Information:
    • Business means, any person who, within the unincorporated areas of Lumpkin County, engages in or causes to be engaged in and/or represents himself to be engaged in any occupation or activity with the object of gain, benefit or advantage either directly or indirectly. Any person advertising by any means, including but not limited to, signs, cards, circulars and newspapers, that he is engaged in any business of any kind, shall be liable for the appropriate occupation tax required under the Lumpkin County Occupational Tax Ordinance and the appropriate fee therefore. • Employee means an individual whose work is performed under the direction and supervision of the employer and whose employer withholds FICA, Federal income tax or State income tax from such individual’s compensation or whose employer issues to such individual for purposes of documenting compensation a form I.R.S. W-2, but not a form I.R.S. 1099. Employee also includes owners, partners, officers or managers who work for a business, whether or not such person is salaried. • Occupational Tax means a tax levied on persons, partnerships, corporations or other entities for engaging in an occupation, profession or business for revenue raising purposes • Business License refers to the certificate issued by the County that indicates the business in question has paid their occupational tax for a specific year. The certificate for the appropriate year must be posted in an easily visible, prominent place in the business.
100. Total number of employees (Add numbers from 1 & 2 above.
102. 
104. Amount of Occupation Tax due based on number of employees from table above:
     *After June 30, only half of the tax liability in the above table will be assessed.*
106. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
108. Electronic Signature
     By agreeing to electronic signature, you further agree that the information contained and provided in this application is true and correct to the best of your knowledge.
110. Title:
111. Date:
113. Upon completion of this form you may choose to submit or submit and print. If you choose submit and print, a browser will open with your form, to access the credit card portal simply close the tab after printing your form and the payment portal will appear. If you choose to pay via check or money order, you may close your browser after printing and disregard the payment portal.
Leave This Blank:


115. 1. Receive an email copy of this form.
116. Email address

     This field is not part of the form submission.

117. Submit Submit and Print

* indicates a required field