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BUSINESS OCCUPATION TAX and/or REGULATORY FEE APPLICATION County of Crisp State of Georgia 210 South 7th Street Room 309 Cordele Georgia 31015 phone 229-276-2673 fax 229-276-2639 Please type or print Year Penalty for failure to file and pay by June 30 Filing Period April 1 to June 30 Business Name Business Location Business Mailing Address Business Start Date Telephone Number s Dominant Line of Business or Business Description Fax No State Sales .

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