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Fill a Valid Georgia Att 15 Template

The Georgia ATT 15 form is an application used to obtain a permit for individuals who represent businesses involved in the sale of alcoholic beverages. This form is essential for salesmen and representatives of licensed wholesalers, importers, and brokers of wine or malt beverages, as well as those associated with licensed wineries or breweries. Completing the ATT 15 accurately ensures compliance with Georgia's regulations regarding alcohol sales.

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Contents

The Georgia Att 15 form is a crucial document for individuals seeking to obtain an alcohol permit in the state. This application is specifically designed for salesmen or representatives who wish to sell alcoholic beverages. Each applicant must complete a separate form, ensuring that all information is accurate and clearly presented. The form requires essential details such as the applicant's Georgia State Taxpayer Identifier, legal business name, and type of permit being requested. Additionally, it collects personal information, including the applicant's Social Security Number, date of birth, and contact details. Applicants must also disclose their employment history and any previous involvement with government authorities related to alcohol sales. Notably, the form includes a section for applicants to confirm their lawful presence in the United States, which is a legal requirement. Payment details are outlined as well, specifying fees based on the type of alcohol business the applicant represents. The application must be signed, notarized, and mailed to the Georgia Department of Revenue to ensure proper processing.

Georgia Att 15 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

SOCIAL SECURITY NUMBER

LAST, FIRST, MIDDLE INITIAL

DATE OF BIRTH

NUMBER AND STREET ADDRESS (Residence)

NUMBER AND STREET ADDRESS (Additional Space)

CITY

STATE

ZIP CODE

COUNTY

COUNTRY

AREA CODE, BUSINESS PHONE NO.

AREA CODE, HOME PHONE NO.

YEARS OF RESIDENCE

(

)

(

)

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.

Download Georgia Att 15

Document Breakdown

Fact Name	Description
Form Purpose	The Georgia ATT 15 form is used to apply for an alcohol permit for salesmen or representatives. Each applicant must submit a separate application.
Identification Requirement	Applicants must provide their Georgia State Taxpayer Identifier. If they do not have one, that field can be left blank.
Permit Types	There are several types of permits available, including those for wholesalers, wineries, and breweries. Fees may vary depending on the type of permit.
Employment History	Applicants must disclose their employment history for the past five years, including the name and address of employers and positions held.
Notarization Requirement	The application must be signed by the applicant and duly notarized to be considered valid.
Governing Law	This form is governed by Georgia law, specifically O.C.G.A. 50-36-1, which requires verification of lawful presence in the U.S.

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