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2. Lumpkin County, Georgia Farm Winery Excise Tax report
4. IMPORTANT:
   This report must be filed and the tax paid by the 10th day of the month following the month in which the wine was sold under the Lumpkin County Alcoholic Beverage Ordinance in order to avoid violation penalties. If the tax is not filed and the tax is not paid by the 10th of the month there is a 10% penalty. There will also be a $25.00 non-filing fee for every month the tax is not filed and paid.
6. This Report Covers the month of:
   -- Select One --JanuaryFebruaryMarchApril MayJuneJulyAugustSeptemberOctoberNovemberDecember
7. Select Year
   -- Select One --20192020202120222023
9. Business Name
10. Contact Person
12. Address
14. City
15. State
16. Zip Code
18. Phone Number
19. Georgia Sales Tax Number
23. Line 1: Number of liters of wine sold
24. Line 2: Tax due Lumpkin County (Line 1 times $0.22)
    Multiply Line 1 by $0.22 and enter that amount.
26. Penalty
    If you are filing after the 10th day of the month, multiply Line 2 by 10% and enter amount.
27. Non-filing fee.
    If this report is for a month not previously filed, add $25 for every month not filed.
29. Total Amount Due:
31. You may pay by credit card or by mailing a check. Checks should be made payable to the Lumpkin County Board of Commissioners and mailed to: Lumpkin County Board of Commissioners Attn: County Clerk 99 Courthouse Hill, Suite H Dahlonega, Georgia 30533
33. Electronic Signature Agreement

    Statement: I do hereby declare under penalty of law that the information contained in this report is true and accurate to the best of my knowledge. Further, by checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature
36. Title
38. Date
    Date
39. Upon submission:
    A print and submit function is enabled on this form. To pay by check, print your form. To pay by credit card, please close the form after printing for your records and you will be automatically directed to the payment portal.
41. Lumpkin County uses a third party to process card payments. If you choose to pay by card, you will be directed from our site to NMI's payment gateway.
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

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