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Business License 38250 Sierra Highway Palmdale, CA 93550 661/247-8384 661/267-5434 [EMAIL REDACTED] [EMAIL REDACTED] Page 1 of 3 Solicitor-Charitable Organization Fundraiser Business Permit Application REV. 10/11/22 CHARITABLE ORGANIZATION CONDUCTED BY FUNDRAISER NOTICE OF INTENTION TO SOLICIT This Application is for (check one) New Permit Annual Renewal Name of Charitable Organization: Principal Business Address: Local Business Address: Telephone Number and Email: Names, addresses, and telephone numbers of the principal officers and members of the board of trustees or board of directors of the named charitable organization: List the purpose for which the solicitation is to be made, the total amount of contributions proposed to be raised, and the use or disposition to be made of the contributions received from the solicitation: A description of the method or methods to be used in conducting the solicitation, and the times and dates proposed for soliciting: The name, residence address and telephone number of the person or persons who will be in direct charge of being responsible for conducting the solicitation: The name, residence address and telephone number of each solicitor who will participate in the solicitation: ---PAGE BREAK--- Business License 38250 Sierra Highway Palmdale, CA 93550 661/247-8384 661/267-5434 [EMAIL REDACTED] [EMAIL REDACTED] Page 2 of 3 Solicitor-Charitable Organization Fundraiser Business Permit Application REV. 10/11/22 A description of the nature and extent of charitable work being performed in the City by the named charitable organization: If a commercial fundraiser for charitable purposes is to be engaged, and is to be paid a set fee rather than a percentage of the total amount raised, please list the estimated total cost to be incurred for direct fundraising expenses: If the solicitation is not a sales solicitation, the applicant may include a statement, in lieu of estimating the total amount of fundraising expenses to be incurred, that an audited statement of these fundraising expenses may be obtained by contacting the organization. I declare under penalties of perjury that this application is true and correct to the best of my knowledge and belief. Officer of Commercial Fundraiser: Signature Title Date I declare under penalties of perjury that this application is true and correct to the best of my knowledge and belief. Officer of Charitable Organization: Signature Title Date INFORMATION THAT MUST BE ATTACHED TO THIS APPLICATION: 1. Application must be presented to the Director 15 days prior to any proposed solicitation in the City of Palmdale. 2. The original or a certified copy of the resolution, agreement, letter of consent, or similar documentation, which authorizes the agency relationship between the named charitable organization and the commercial fundraiser for charitable purposes. ---PAGE BREAK--- Business License 38250 Sierra Highway Palmdale, CA 93550 661/247-8384 661/267-5434 [EMAIL REDACTED] [EMAIL REDACTED] Page 3 of 3 Solicitor-Charitable Organization Fundraiser Business Permit Application REV. 10/11/22 3. Copy of documents from the Internal Revenue Service and the California Franchise Tax Board that establish the tax-exempt status of the named charitable organization. 4. If, during the period for review of the Notice of Intention, or during the term of any permit issued for the solicitation, there is any significant change in fact, policy or method that would alter the information set forth in the Notice of Intention, the applicant must notify the Director in writing within 48 hours after that change. 5. Each person taking part in the solicitation of funds for the purpose of issuing a badge which must be worn on the clothing in plain sight during all times soliciting in Palmdale is taking place. Any person while in Palmdale may inspect this badge. OFFICE USE ONLY Planning Manager: Signature Date