Tax Compliance Form.doc
DOC document 1 MB Posted
- Solicitation number
- PE-55267-NONST-2026-000000038
- Issued by
- Jefferson County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia, Department of Revenue (DOR), required for suppliers seeking contract awards with Georgia state entities. The form requires suppliers to provide comprehensive tax identification and registration information, including the supplier's name, physical location, Federal Identification Number (FEI), and any applicable State Taxpayer Identification Number (STI), Sales and Use Tax Number, and Withholding Tax Number. Suppliers must also disclose whether they have been previously registered in Georgia, detail the types of services to be performed and any tangible personal property or goods to be sold, and identify all affiliate companies with their corresponding tax identification numbers. Additionally, suppliers must designate a person responsible for handling the company's tax issues, including their name, telephone number, and email address.
Upon contract consideration, the state entity will submit the supplier's information to the Georgia Department of Revenue for verification that the supplier is not a "prohibited source" as defined by O.C.G.A. 50-5-82 and to confirm there are no outstanding tax issues. Missing, incomplete, or erroneous data may delay or prohibit verification of contract eligibility. State entities must submit the completed form to DOR at tsd-state-contractors@dor.ga.gov in accordance with the Georgia Procurement Manual. Suppliers are strongly encouraged to verify their current tax status and resolve any outstanding tax liabilities or missing tax returns prior to submission to avoid disqualification from contract award.
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Text version
TAX COMPLIANCE
INSTRUCTIONS TO SUPPLIERS
Please complete the following information:
· Supplier’s Name:
· Physical Location Address:
· Federal Identification Number (FEI):
· Have you ever been registered in the State of Georgia?
· If so, please provide the following information, if applicable:
· State Taxpayer Identification Number (STI):
· Sales and Use Tax Number:
· Withholding Tax Number:
· What type of service will you perform?
· Will you sell any tangible personal property or goods?
· Supplier’s Affiliate’s Name:
· FEI:
· STI:
· Sales and Use Tax Number:
· Withholding Tax Number:
If there is more than one affiliate, please attach a separate sheet listing the information above.
· Person responsible for handling supplier’s tax issues (such as the CFO, the company tax officer, etc.):
· Name:
· Telephone Number:
· E-mail Address:
NOTICE TO SUPPLIER:
In the event the supplier is considered for contract award, the information provided in the form will be submitted by the State Entity to the Georgia Department of Revenue (“DOR”) for a determination as to whether the supplier is a “prohibited source” (as defined by O.C.G.A. §50-5-82) or whether there are any other outstanding tax issues. MISSING, INCOMPLETE, OR ERRONEOUS DATA MAY DELAY OR PROHIBIT VERIFICATION OF YOUR ELIGIBILITY FOR CONTRACT AWARD. NO PROHIBITED SOURCE MAY RECEIVE CONTRACT AWARD; THEREFORE, YOU ARE STRONGLY ENCOURAGED TO CHECK YOUR TAX STATUS NOW AND RESOLVE ANY OUTSTANDING TAX LIABILITIES AND/OR MISSING TAX RETURNS.
STATE ENTITY: Please submit this form via email to DOR at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
Revised: 12/22/2010
SPD-SP045
An Equal Opportunity Employer
File details come from the government source that posted it. Updated .