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CITY OF FONTANA 8353 SIERRA AVE. FONTANA, CA 92335 APPLICATION FOR CHARITY SOLICITATION ANNUAL PERMIT APPLICANTS MUST SUBMIT THE FOLLOWING: (Per FCC Sec. 15-1 ) Articles of Incorporation and/or Bylaws Determination Letter of Exempt Status, U.S. Treasury Determination Letter of Exempt Status, State Franchise Tax Board Legal Name of Organization: State or Federal I.D. Number Type of Organization Date Organized Contact Person & Title Permanent Meeting Address Days and Times of Meetings Mailing Address Telephone Number E-mail Address Funds raised will be for the purpose of: Charitable Religious Veterans Patriotic Civic Betterment Welfare Scholastic ___Other Whenever, in the opinion of the collector, the activity for which the charity solicitation license is requested results in any expense to the City, such as police protection or any other direct or indirect expenses, the collector shall refer the request for such license to the City Council for its decision, in which event the City Council shall have the right to impose a reasonable charge to cover such expense. (FCC Sec. 15-1 PLEASE COMPLETE BOTH SIDES ---PAGE BREAK--- LIST OF OFFICERS: President: Address: Date of Birth Telephone Drivers License Number: ID Vice President: Address: Date of Birth Telephone Drivers License State ID Secretary: Address: Date of Birth: Telephone Drivers License Number: State ID Treasurer: Address: Date of Birth: Telephone Drivers License Number: State ID the of Applicant Name Office Held Organization Do hereby declare under the penalty of perjury that this application and any attachment thereto have been examined by me and to the best of my knowledge and belief represent a true and complete statement of facts. Signature Date Print name NOTE: THIS PERMIT DOES NOT AUTHORIZE THE ORGANIZATION TO CONDUCT CARWASHES, BINGO, CARNIVALS, DANCES, OR PARTICIPATE IN THE FONTANA DAYS CELEBRATION. OFFICE USE ONLY Account Number Police Planning Building & Safety Community Services