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2. Lumpkin County, Georgia Per Drink Excise Tax (on Distilled Spirits) Report Form
4. Instructions
   This report must be filed and the tax paid by the 10th of the month following the month in which the tax was collected to avoid a possible fine, suspension of license, or loss of license. (See Lumpkin County Code of Ordinances for further information.)
6. Business Name
7. Georgia Sales Tax Number
9. Lumpkin County Alcoholic Beverage License Number
11. This Report Covers Tax Collected During the Month of:
    -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
12. Year
    -- Select One --20192020202120222023
16. Computation of Amount to be Remitted
18. Line 1: Gross Sales Proceeds
20. Line 2: Less Deduction
    The deduction is equal to rate authorized for deductions from state tax under part V of the Georgia Retailer's and Consumer's Sales and Use Tax Act, O.C.G.A. § 48-8-50, provided the tax is not delinquent at the time of payment.
22. Line 3: Net Taxable Proceeds (subtract Line 2 from Line 1)
24. Line 4: Total Tax to be Paid (Line 3 X 3.00%) remitted by the 10th of the month.
26. NOTE: If no late payment, enter $0 for Line 5 and proceed to Line 6
28. Line 5: Late Payment Penalty ($25 for every month late (after 20th of month)
30. Line 6: Total Tax and Penalty to be Paid (add Line 4 & 5)
32. NOTE: Reports must be received by our office by the 10th of the month. Post marked date does not qualify as received.
34. 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
36. Electronic Signature Agreement

    Statement: I do hereby declare that under penalty of law that the information contained in this report is tur 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.
38. Electronic Signature
39. Title
41. Date
    Date
42. Upon Submission:
    A print and submit function is enabled on this form. To pay by check, simply print your form. To pay by credit card, please close the form after printing a copy for your records and you will be automatically directed to the payment portal.
44. 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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46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

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