Who files the Coin Operated Amusement Machines Declaration Form?

A location owner or operator in Powder Springs offering one or more coin operated amusement machines to the public submits the declaration.

What supporting documents does the form list?

The checklist lists copies of the location and master owners’ state licenses, other city licenses or registrations, the latest monthly report submitted to the state or Georgia Lottery, and the agreement between the machine owner and location owner or operator.

Do I need a notary for the Coin Operated Amusement Machines Declaration Form?

No. The document has signature and date fields but no notary block. It lists supporting documents to attach, but does not say any attachment or related step must be notarized or sworn.

How do I submit the declaration?

Send the form and listed supporting documents to the Community Development Department at 4181 Atlanta Street, Powder Springs, GA 30127, or email commdev@cityofpowdersprings.org.

Powder Springs, GA · Cobb County

No notary required

Coin Operated Amusement Machines Declaration Form

City location owners or operators use this form to report coin operated amusement machines and provide ownership and business information.

What this form is

A location owner or operator offering coin operated amusement machines to the public submits this declaration before the city issues or renews an occupational tax certificate or license. The form asks for business and machine-owner details, machine counts, and a signature, and lists supporting documents to include. The PDF also contains a monthly report form and the city ordinance sections addressing these machines.

Who needs it

A business location owner or operator offering one or more coin operated amusement machines to the public in the city needs this declaration.

How to submit it

Submit the form and listed supporting documents to the Community Development Department, 4181 Atlanta Street, Powder Springs, GA 30127, or email [email protected].

About notarization

This document is signed and dated without a notary; the form lists supporting documents to attach, but does not say any attachment or related step must be notarized or sworn.

How to submit this form

1
Download The Form
Download the Coin Operated Amusement Machines Declaration Form PDF.
2
Complete The Declaration
Enter the business location and machine-owner information, machine counts, and the location owner or operator’s signature and date.
3
Gather The Listed Documents
Use the submission checklist to gather copies of the state licenses, other city licenses or registrations, latest monthly report, and owner agreement.
4
Submit To The City
Send the completed form and supporting documents to the Community Development Department by the listed address or email.

Frequently asked questions

Who files the Coin Operated Amusement Machines Declaration Form?: A location owner or operator in Powder Springs offering one or more coin operated amusement machines to the public submits the declaration.
What supporting documents does the form list?: The checklist lists copies of the location and master owners’ state licenses, other city licenses or registrations, the latest monthly report submitted to the state or Georgia Lottery, and the agreement between the machine owner and location owner or operator.
Do I need a notary for the Coin Operated Amusement Machines Declaration Form?: No. The document has signature and date fields but no notary block. It lists supporting documents to attach, but does not say any attachment or related step must be notarized or sworn.
How do I submit the declaration?: Send the form and listed supporting documents to the Community Development Department at 4181 Atlanta Street, Powder Springs, GA 30127, or email [email protected].

Need something notarized?

This Coin Operated Amusement Machines Declaration Form doesn’t need a notary — but if you have another Powder Springs form that does, a commissioned online notary can help.