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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 2 Solicitor-Charitable Organization Business Permit Application REV. 10/11/22 CHARITABLE ORGANIZATION 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: A description of the nature and extent of charitable work being performed in the City by the named charitable organization: ---PAGE BREAK--- Business License 38250 Sierra Highway Palmdale, CA 93550 661/247-8384 661/267-5434 [EMAIL REDACTED] [EMAIL REDACTED] Page 2 of 2 Solicitor-Charitable Organization Business Permit Application REV. 10/11/22 INFORMATION THAT MUST BE ATTACHED TO THIS APPLICATION: 1. Application must be presented to the Manager 15 days prior to any proposed solicitation in the City of Palmdale. 2. Copy of documents from the Internal Revenue Service and the California Franchise Tax Board, which establish the tax-exempt status of the named charitable organization. 3. 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. 4. All information set forth in the Notice of Intention, and any additional information provided by the applicant relating to that Notice will be a matter of public record and will be open to public inspection. 5. Photographs of each person will be taken at City of Palmdale Human Resources. Issued badge which must be worn on the clothing in plain sight during all times soliciting in the City of Palmdale. Any person while in Palmdale may inspect this badge. If the organization issues its own identification cards to its solicitors, please submit a copy of the cards for authorization by the Planning Manager. I declare under penalties of perjury that this application is true and correct to the best of my knowledge and belief. Signature of Applicant Date OFFICE USE ONLY Planning Manager: Signature Date