APPLICATION FOR OCCUPATIONAL TAX CALENDAR YEAR APPLICATION VOID AFTER 60 DAYS

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HENRY COUNTY OCCUPATIONAL TAX DIVISION 140 HENRY PARKWAY MCDONOUGH, GA. 30253 PHONE 770-288-8180 FAX 770-288-8190 APPLICATION FOR OCCUPATIONAL TAX CALENDAR YEAR APPLICATION VOID AFTER 60 DAYS TYPE OF APPLICATION: NEW RENEWAL AMENDED APPLICATION FOR HOME OCCUPATION PCH OCCUPATIONAL TAX # BUSINESS/CORP.NAME BUSINESS PHONE # ( ) FAX PHONE # ( ) BUSINESS LOCATION SUITE CITY STATE ZIP MAILING ADDRESS CITY STATE ZIP CODE BUSINESS OWNER TITLE HOME ADDRESS CITY STATE ZIP CODE HOME PHONE ( ) DRIVERS LIC # STATE DESCRIPTION OF BUSINESS FEDERAL OR STATE LICENSE # NAME NUMBER EXP. DATE YOU MUST ATTACH A COPY OF CURRENT FEDERAL OR STATE LICENSE APPLICABLE TO BUSINESS TYPE. I,, AFFIRM THAT THE FACTS STATED BY ME ARE TRUE. I UNDERSTAND ANY MISREPRESENTATION OR FRAUDULENT STATEMENT IS GROUNDS FOR AUTOMATIC DISMISSAL OF THIS APPLICATION AND/OR REVOCATION OF THE LICENSE. I UNDERSTAND THAT MY BUSINESS MUST BE OPERATED IN COMPLIANCE WITH ALL APPLICABLE STATE, FEDERAL & LOCAL LAWS, ORDINANCES & REGULATIONS. THE GRANTING OF THIS BUSINESS LICENSE OR PAYMENT OF THIS OCCUPATIONAL TAX DOES NOT WAIVE THE RIGHT OF ANY FEDERAL, STATE OR LOCAL ENTITY TO REGULATE & ENFORCE ALL LAWS, ORDINANCES & REGULATIONS. THIS DAY OF,. SIGNATURE OF APPLICANT TITLE DATE SIC# E-VERIFY # TOTAL AMT.DUE PROPERTY ZONED APPROVED/DENIED ZONING APPROVED/DENIED CBI APPROVED/DENIED FIRE MARSHALL APPROVED/DENIED - POLICE APPROVED/DENIED ENVIRONMENTAL HEALTH APPROVED/DENIED - OTHER PARCEL ID#

1. How do you plan to use your home in this business venture? 2. If you are storing equipment or products, where will they be stored? 3. If you are using a vehicle, other than a passenger vehicle, for your business, where will the vehicle be located? 4. Please add any information regarding your home occupation that might be helpful in approving your business license. E-Mail address Number of Employees Actual gross receipts for year, or if not in business estimate for 12 months. $ (gross receipts). OR ESTIMATE FOR 12 MONTHS

LEGAL STATUS AFFIDAVIT Please read carefully and check the appropriate box: THIS FORM MUST BE ATTACHED & RETURNED 1. If you are a United States citizen 18 years of age or older please check #1 below. 2. If you are a qualified alien or nonimmigrant under the federal Immigration and Nationality Act 18 years of age or older and lawfully present in the United States, please attach a copy of your Alien Registration Card and please check #2 below. Pursuant to Official Code of Ga. Annotated (OCGA) sec. 50-36-1, verification of legal status is required for the administration of various public services/public benefits as defined in the Ga. Security and Immigration Compliance Act (GSICA). Accordingly, applicants for various public benefits must certify on the following. 1. The applicant must execute an affidavit that he or she is a United States citizen or legal permanent resident 18 years of age or older: or 2. The applicant must execute an affidavit that he or she is a qualified alien or nonimmigrant under the federal Immigration and nationality act 18 years of age or older lawfully present in the United States. I, as applicant for public services/public benefits as defined in the Ga. Security and Immigration Compliance Act (GSICA) certify my legal status to be in the United States of America as marked above, I understand that there may be state and or federal penalties for providing false information on this affidavit required under the Ga. Security and Immigration Compliance Act. Alien Registration Number for Non-Citizens Printed Name of Applicant Signature of Applicant Home Address: Business Lic/Account No. Date of Affidavit Notary Notary Seal

Private Employer Exemption Affidavit Pursuant to O.C.G.A 36-60-6 (d) By executing this affidavit, the undersigned private employer verifies that it is exempt from compliance with O.C.G.A 36-60-6, stating affirmatively that the individual, firm or corporation employs less than ten (10) employees and therefore, is not required to register with and/or utilize the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A 13-10-90. Signature of Exempt Private Employer Printed Name of Exempt Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on,, 201 in (city), (state) Signature of Authorized Officer/Agent Printed Name and Title of Authorized Officer/Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF,201. NOTARY PUBLIC MY COMMISSION EXPIRES:

Henry County ULDC Requirements 7.01.00 HOME OCCUPATIONS 7.01.01 Generally A. A home occupation is permissible in a lawfully established dwelling unit in any residential zoning district. Home occupations shall meet the standards set forth in this section. B. The following and similar uses shall be considered home occupations: 1. Office for professionals, such as attorneys, drafters, realtors, insurance agents, engineers, architects, and other consultants; 2. Instruction or teaching, such as academic tutoring, performing arts, or fine arts; 3. Administrative or clerical support services, such as transcription, court reporters, stenographers, notary republic, or addressing services; 4. Personal services, such as beauty or barber shop, manicurists, dress-making or tailoring; 5. Pet grooming; 6. Child day care or nursery school for six (6) or fewer children; 7. Adult day care for six (6) or fewer adults; 8. Personal Care Home for three (3) or fewer persons; 9. Medical Practitioner (excluding veterinarians); 10. Manufacturers' and internet sales representative; 11. Studios for artists, or photographers; C. Agricultural activities associated with the raising of crops and farm animals on properties over three (3) acres in size shall not be subject to the requirements for home occupations. D. Activities not listed are prohibited as home occupations. 7.01.02 Standards for All Home Occupations A. All home occupations shall obtain a business license from Henry County. B. Employees of the home occupation shall be limited to the residents of the dwelling. C. The home occupation shall be clearly incidental to the residential use of the dwelling. 1. The use of the dwelling for a home occupation shall not change the residential character of the building. 2. No internal or external alterations which are inconsistent with the residential use or character of the dwelling shall be permitted. D. Products for sale or use in the home occupation shall not be visible from the street. E. Use of a dwelling for a home occupation shall not exceed twenty-five (25) percent of the total square footage of one (1) floor, except for Personal Care Homes and Adult or Child Day Care.

1. Floor plans shall be provided to reflect the dimensions of the entire floor and room which will be utilized for the home occupation. Each floor plan shall be drawn to scale. F. The home occupation shall not constitute a nuisance to the surrounding neighborhood. G. Outside storage of materials used in connection with a home occupation is prohibited. H. A home occupation shall not use or be located in an accessory building. I. Only passenger vehicles shall be used in connection with the operation or management of a home occupation. J. No business shall be conducted between the hours of 8:00 p.m. and 7:00 a.m. 7.01.03 Standards for Specific Home Occupations A. Instruction shall be limited to two (2) students at any one (1) given time. B. Beauty shops, barber shops, manicurists, pet grooming and similar services shall be limited to two (2) chairs or stations and one (1) shampoo chair or station. There shall be no more than two (2) clients on the property at any one (1) given time. C. Personal Care Homes and Adult or Child Day Care Facilities shall provide an approved State License prior to the issuance of a County Business License. 7.01.04 Specific Standards for Agricultural Home Occupations in the RA Zoning District A. Agricultural product sales shall be allowable in the RA zoning district, provided that the lot or parcel is not part of a subdivision. B. Notwithstanding the provisions in Section 7.01.02 above, agricultural products grown on the premises in the RA zoning districts may be visible from the street. C. Only agricultural products produced on the premises may be sold on the premises. D. Trucks and vehicles other than passenger vehicles may be used in connection with the operation of an agricultural home occupation. E. An accessory building may be used in connection with an agricultural home occupation, subject to compliance with the following standards: 1. The accessory building shall maintain a residential appearance. 2. No automotive painting, body work, salvage, major automotive or heavy equipment repairs are to be conducted. 3. No machinery or equipment shall be used which generates noise detectable outside the accessory structure. Signature Date Witness