Georgia Form Att 15 PDF Details

The Georgia ATT-15 form serves as an essential application for individuals seeking permits as salesmen or representatives in the alcohol industry within the state. This comprehensive form, revised in May 2011, outlines the necessary steps and requirements for applicants, including the provision of personal and employment details, such as social security number, date of birth, home address, and a brief employment history. Important to note, the form necessitates typing or printing in blue ink to avoid any processing delays and requires a separate application for each applicant. Additionally, the ATT-15 form includes sections on any past involvement with government authorities, further employment history over the past five years, and specific questions related to any interests in alcoholic beverage businesses. The application process is finalized with a signature from the applicant, signifying under penalty of perjury that all provided information is accurate. For individuals representing licensed wholesalers or manufacturers of distilled spirits, there is a nominal fee, whereas no fee is required for representatives of licensed wineries, breweries, wholesalers of wine, or malt beverages. Payment, when necessary, must be made payable to the Georgia Department of Revenue, and the form, once completed, is to be mailed to the referenced address. Additionally, there are instructions for verifying lawful presence in the United States, crucial for compliance with O.C.G.A. 50-36-1. For successful application processing, it is critical that all parts of the form are properly filled and that any applicable fees are paid in full.

QuestionAnswer
Form NameGeorgia Form Att 15
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesATD_APPLICATION _FOR_ALCOHOL_PE RMIT_ATT15 ga dept of revenue att 15 form

Form Preview Example

ATT-15 (REV. 5/11)

APPLICATION FOR ALCOHOL PERMIT

INSTRUCTIONS FOR COMPLETION OF THE APPLICATION FOR ALCOHOL PERMIT (ATT-15)

Use this form to obtain a permit for any salesmen or representative. Provide a separate application for each applicant.

TYPE OR PRINT IN BLUE INK - DO NOT USE PENCIL

INSTRUCTIONS FOR COMPLETING:

Line 1

Enter your Georgia State Taxpayer Identifier. (If you do not have one, leave blank).

Line 2

Enter the name and address under which your business is registered with the Secretary of State.

 

If your business is not registered, then enter the name under which your business owns property or

 

acquires debt. If the business is a partnership, the legal name is the partnership name. In the case of

 

a sole proprietorship, the legal name is the name of the individual owner of the business.

Line 3

Check the type of permit for which you are applying.

Line 4-11

Provide the following information about the applicant:

 

* Social Security Number

 

* Name of applicant

 

* Date of birth

 

* Home address

 

* Email

 

* Fax number

 

* Home telephone number

 

* Number of years of residency at above address

 

* Previous home address

Line 12

Enter previous home address.

Line 13

Enter the number of years applicant has been employed by company identified in Lines 1 and/or 2.

Line 14

Check “Yes” or “No” in the spaces provided.

Line 15-19

If Line 14 is yes, provide the following information for each alcoholic beverage business in which the

 

applicant has an interest (if more than one business, attach additional sheets with the information

 

requested below):

 

* State Taxpayer Identifier or business interest

 

* Name of business interest

 

* Alcohol License Number

 

* Business location address

 

* Business telephone number

Line 20

Provide information regarding any previous involvement with government authorities.

Line 21

Provide the following employment history information:

 

* Month and year employed from

 

* Name of previous employer

 

* Address of previous employer

 

* Position applicant held

ATT-15 (REV. 5/11)

INSTRUCTIONS FOR SIGNING:

This application must be signed by the applicant and duly notarized.

INSTRUCTIONS FOR PAYMENT:

There is no registration fee for a salesman or representative of a licensed wholesaler, importer, or broker of wine or malt beverages or of a licensed winery or brewery. The fee for a salesman or representative of a licensed wholesaler or producer distilled spirits $10.00 per person. A check or money order for the appropriate fee must be made payable to the GEORGIA DEPARTMENT OF REVENUE. Georgia law stipulates that taxes and fees shall be paid in lawful money of the U.S. and be free of any expense to Georgia.

Each Salesman or Representative applicant of a licensed liquor wholesaler must complete and attach a Personal Statement (ATT-17) and complete the Georgia Automated Fingerprint Procedure (GAPS). Examiners conducting the investigations for permits will provide an instructional package on how to successfully complete the GAPS registration process.

A fee of $52.90 is charged by Cogent Systems to each applicant being fingerprinted. Payment must be at time of registration. Credit card, money order or cashiers check payable to “Cogent Systems-GAPS”.

INSTRUCTIONS FOR MAILING AND REQUESTING INFORMATION:

Confirming company and applicant should retain a copy of this application for his file and for inspection by the Revenue Commissioner or designated Agents. Mail the original to the address shown below. If you have any questions or need assistance in completing the application, call (404) 417-4870.

GEORGIA DEPT OF REVENUE

ALCOHOL & TOBACCO DIVISION

P.O. BOX 49728

ATLANTA, GEORGIA 30359

THE PROCESSING OF THIS APPLICATION WILL BE DELAYED UNLESS IT IS PROPERLY SIGNED, COMPLETE INFORMATION FURNISHED, AND APPLICABLE QUESTIONS ANSWERED.

ATT-15 (REV. 5/11)

GEORGIA DEPT OF REVENUE ALCOHOL & TOBACCO DIVISION P.O. BOX 49728

ATLANTA, GEORGIA 30359

OFFICE USE

Promotional

APPLICATION FOR ALCOHOL PERMIT

OFFICE USE

ONLY

 

1.

STATE TAXPAYER IDENTIFIER

 

STATE LICENSE NUMBER

 

 

 

 

 

 

2.

LEGAL BUSINESS NAME

D/B/A

 

 

 

 

 

 

 

LEGAL BUSINESS ADDRESS (City, State, and Zip Code):

 

 

3.FOR WHICH TYPE OF PERMIT ARE YOU APPLYING?

[] BUSINESSMAN OR REPRESENTATIVE OF A REGISTERED PRODUCER OF DISTILLED SPIRITS - FEE $10.00

[] SALESMAN OR REPRESENTATIVE OF A LICENSED WHOLESALER OF DISTILLED SPIRITS - FEE $10.00

[] SALESMAN OR REPRESENTATIVE OF A LICENSED WHOLESALER OF WINE - NO FEE

[] SALESMAN OR REPRESENTATIVE OF A LICENSED WINERY, IMPORTER, OR BROKER OF WINE - NO FEE

[] SALESMAN OR REPRESENTATIVE OF A LICENSED BREWERY, IMPORTER, OR BROKER OF MALT BEVERAGES - NO FEE

[] SALESMAN OR REPRESENTATIVE OF A LICENSED WHOLESALER OF MALT BEVERAGES - NO FEE

4.

SOCIAL SECURITY NUMBER

LAST, FIRST, MIDDLE INITIAL

 

 

 

 

DATE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

5.

NUMBER AND STREET ADDRESS (Residence)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

NUMBER AND STREET ADDRESS (Additional Space)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

CITY

 

STATE

 

ZIP CODE

 

COUNTY

COUNTRY

 

 

 

 

 

 

 

 

 

 

8.

AREA CODE, BUSINESS PHONE NO.

 

AREA CODE, HOME PHONE NO.

 

YEARS OF RESIDENCE

 

(

)

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

FAX NO.

 

 

E-MAIL ADDRESS

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

NUMBER AND STREET (Additional Space)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

NUMBER AND STREET (Previous address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

CITY

 

STATE

 

ZIP CODE

 

COUNTY

COUNTRY

 

 

 

 

 

 

 

 

 

 

13.

HOW LONG HAVE YOU BEEN EMPLOYED BY THE ABOVE FIRM?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

DO YOU HAVE ANY INTEREST, DIRECTLY OR INDIRECTLY, IN ANY OTHER ALCOHOLIC BEVERAGE BUSINESS?

 

[

] YES

[ ] NO (if “Yes”, provide the following):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

STI NUMBER

LEGAL BUSINESS NAME

 

 

 

ALCOHOLIC LICENSE

 

 

 

 

 

 

 

 

 

 

 

16.

NUMBER AND STREET ADDRESS (Business)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

NUMBER AND STREET ADDRESS (Additional Space)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

CITY

 

STATE

 

ZIP CODE

 

COUNTY

COUNTRY

 

 

 

 

 

 

 

 

 

 

 

 

 

19.AREA CODE, PHONE NUMBER

( )

20.HAVE YOU EVER BEEN ARRESTED, OR HELD BY FEDERAL, STATE, OR OTHER LAW-ENFORCEMENT AUTHORITIES, FOR ANY VIOLATION OF ANY FEDERAL LAW, STATE LAW, COUNTY OR MUNICIPAL LAW, REGULATION OR ORDINANCE?

(Do not include traffic violations. All other charges must be included even if they are dismissed. Give reason charged or held, date, place were charged and disposition.)

ATT-15 (REV. 5/11)

APPLICATION FOR ALCOHOL PERMIT

OFFICE USE

ONLY

21.PROVIDE EMPLOYMENT HISTORY FOR THE PAST FIVE (5) YEARS

FROM

 

 

Month

Year

EMPLOYER’S NAME AND ADDRESS

POSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OATH

I DECLARE UNDER PENALTY OF PERJURY THAT THIS STATEMENT HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS TRUE, CORRECT, AND COMPLETE.

__________________________________

______________________________

_______________________________

Signature

Title

Date

 

(Must be signed by applicant)

 

I HEREBY CERTIFY_____________________________________ IS PERSONALLY KNOWN TO ME, THAT HE SIGNED HIS NAME

TO THE FOREGOING APPLICATION AFTER STATING TO ME THAT HE KNEW AND UNDERSTOOD ALL STATEMENTS AND ANSWERS MADE THEREIN, AND, UNDER OATH ACTUALLY ADMINISTERED BY ME, HAS SWORN THAT SAID STATEMENTS AND ANSWERS ARE TRUE.

THIS________________________ DAY OF ________________________, _________

_________________________________

 

Notary Public

__________________________________________________________________________________________________________

CONFIRMATION OF COMPANY

THE UNDERSTAND FIRM DOES HEREBY CONFIRM THE APPOINTMENT OF THE ABOVE NAMED APPLICANT, AS ITS SALES AND/OR REPRESENTATIVE FOR THE PURPOSE OF PROMOTING AND SELLING ITS PRODUCTS WITHIN THE STATE OF GEORGIA IN ACCORDANCE WITH GEORGIA LAW, AND THE REGULATIONS OF THE STATE OF GEORGIA’S REVENUE COMMISIONER.

________________________________

_______________________________

Signature of Company Official

Title

_________________________________

_______________________________

Name of Company

Date

(To be completed by licensed by Georgia Beverage and Alcohol Supplier or Distributor)

Affidavit of Compliance with O.C.G.A. 50-36-1 “Verification of Lawful Presence within the United States”

O.C.G.A. 50-36-1 requires that applicants applying for such things as licenses for public benefits complete a signed and sworn affidavit verifying the applicant’s lawful presence in the United States. Therefore, the applicant must answer the following questions:

The applicant is a United States citizen or legal permanent resident at least eighteen (18) years old.

Yes ______ No ______

The applicant is a qualified alien or nonimmigrant under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, at least eighteen (18) years old, and is lawfully present in the United States. The applicant’s alien number issued by the Department of Homeland Security or other federal immigration agency must be provided.

Yes ______ No ______

Alien Number ____________________________________

O.C.G.A 50-36-1 states that “Any person who knowingly and willfully makes a false, fictitious, or fraudulent statement of representation in an affidavit executed pursuant to this Code section shall be guilty of a violation of Code Section 16-10-20.”

I declare, under penalty of law, that this affidavit has been completed by me and is true and correct.

___________________________________________________________________________________________

Signature

Title

Date

(Must be signed by applicant. If the applicant is a corporation, must be signed by an officer of the corporation.

STAMPED SIGNATURE IS NOT ACCEPTABLE)

I hereby certify that__________________________________________________________ is personally known, or

verified by me, that the applicant signed this application after stating to me his or her personal knowledge and understanding of all statements and, under oath actually administered by me, has sworn that the statements and answers contained in this affidavit are true.

This _________ day of _____________, ______ .

_______________________________________

 

Notary Public

AFFIX SEAL

 

You must attach a copy of a secure and verifiable document as defined in O.C.G.A. 50-36-2. Such documents include a valid Georgia issued Driver's License or ID Card, a valid Driver's License issued by another State or an identification document issued by the United States Government.

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1. Before anything else, while completing the Georgia Form Att 15, start in the area that features the following fields:

Georgia Form Att 15 completion process clarified (stage 1)

2. Given that the previous array of fields is complete, you're ready insert the essential particulars in NUMBER AND STREET Previous address, CITY STATE ZIP CODE COUNTY COUNTRY, HOW LONG HAVE YOU BEEN EMPLOYED, DO YOU HAVE ANY INTEREST DIRECTLY, YES NO if Yes provide the, STI NUMBER LEGAL BUSINESS NAME, NUMBER AND STREET ADDRESS Business, NUMBER AND STREET ADDRESS, CITY STATE ZIP CODE COUNTY COUNTRY, AREA CODE PHONE NUMBER, and HAVE YOU EVER BEEN ARRESTED OR so you're able to progress to the 3rd step.

Stage number 2 of completing Georgia Form Att 15

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this field, next field, and other fields in Georgia Form Att 15

4. Now start working on this next section! In this case you have all of these FROM Month Year, EMPLOYERS NAME AND ADDRESS POSITION, OATH, I DECLARE UNDER PENALTY OF PERJURY, Signature, Title Date, Must be signed by applicant, I HEREBY CERTIFY IS PERSONALLY, TO THE FOREGOING APPLICATION AFTER, ANSWERS MADE THEREIN AND UNDER, AND ANSWERS ARE TRUE, and THIS DAY OF Notary Public fields to complete.

Georgia Form Att 15 writing process explained (step 4)

5. As you get close to the finalization of your file, you'll notice a few extra requirements that need to be met. Mainly, The applicant is a United States, Yes No, The applicant is a qualified alien, Yes No Alien Number, OCGA states that Any person who, I declare under penalty of law, Signature Title Date, Must be signed by applicant If the, and I hereby certify that is should be done.

Step number 5 of completing Georgia Form Att 15

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