Solicitations Permit Request
HOMEPAGE


POLICE DEPARTMENT
464 N. Rexford Drive
Beverly Hills,
CA 90210-4817		 DAVID L. SNOWDEN
Chief of Police
310.285.2100
310.246.9854 (FAX)
CITY OF BEVERLY HILLS

CHARITABLE SOLICITATIONS COMMISSION

REQUEST FOR PERMIT TO SOLICIT

This application for request to solicit in the City of Beverly Hills is submitted pursuant to Beverly Hills Municipal Code Section 4-3.804.

A. Applicant Information
Name of Organization :
Address :
City, Zip :
Telephone :
Fax :
E-mail :
Name of person to contact in the event there are questions concerning this application :
Name Telephone

B. Are you a 501 (c)(3) organization ?
No
Yes
If yes, please submit the most recent letter your organization received from the IRS recognizing your tax-exempt status. This is a one-time only request.
(Please upload a copy of your document here. If you do not have a document to upload, you may fax it with the signature page of your application.)

C. What is the purpose of this solicitation ?

D. Please estimate the following :
Total amount of funds (Gross) proposed to be raised during this solicitation $
Cost (Expense) of this proposed solicitation $

E. Previous fund-raising event :
Gross : $
Expense : $
Please attach a copy of the financial statement of your previous fund-raising event.
(Please upload a copy of your document here. If you do not have a document to upload, you may fax it with the signature page of your application.)

F. Names of Beneficiaries from this solicitation :
(1)
(2)
(3)

G. Name and address of the person or persons who will disburse the receipts of this solicitation :
(1) Name (2)
(1) Address (2)
(1) City, Zip (2)

H. Name and address of the person or persons who will be in direct charge of conducting the solicitation :
(1) Name (2)
(1) Address (2)
(1) City, Zip (2)

I. Name and address of all promoters connected to or to be connected with the proposed solicitation :
(1) Name (2)
(1) Address (2)
(1) City, Zip (2)

J. Please list the method(s) to be used in conducting the solicitation (e.g., mail, phone or personal contact) :


K. Event Category
Monetary Drive (No Specific Event)
Event Drive (includes an event with specific date & location)

Date, time, type, and location of Event :
Date/Time : CHOOSE DATE  
(e.g.,luncheon, dinner) Type :
Location :

Please list the preferred dates (month/day/year) for beginning and ending such solicitation(*) :
Begin Date : CHOOSE DATE   End Date : CHOOSE DATE  
(*)Per Article 8 CHARITABLE SOLICITATIONS of Chapter 3 of Title 4 of the Beverly Hills Municipal Code: 4-3-808: TERM OF PERMIT: A solicitation permit issued for an event pursuant to this article shall be valid for a period not to exceed one hundred and eighty (180) days from the date of issue, provided further, such permit may be extended for an additional period not exceeding an additional thirty (30) days upon filing a renewal application and demonstrating good cause for such extension. A solicitation permit issued for a monetary drive pursuant to this article shall be valid for a period not to exceed twelve (12) months from the date of issue.

L. List the name and address of any individual who is engaged in and about this solicitation, or is to receive, directly or indirectly, any WAGES, FEES, COMMISSIONS, EXPENSES OR EMOLUMENTS :
(1) Name (2)
(1) Address (2)
(1) City, Zip (2)
Attach additional sheets if necessary.

M. What is the amount of such wages, fees, commissions, expenses or emoluments for the individual(s) listed under item "L" ?
(1) $ (2) $

If the permit to solicit is approved, any individuals listed under item "L" must comply with additional requirements established in the Beverly Hills Municipal Code.

N. Please give a full statement of the character and extent of the charitable or religious work being done by the applicant within the City.

O. Please provide a statement to the effect that if a permit is granted, it will not be used or represented in any way as an endorsement by the City of Beverly Hills, or by any Department or Officer thereof.

P. List other cities or counties where similar permits have been requested, and indicate if such permits were granted or denied.

If, while any application is pending, or during the term of any permit granted thereon, there is any change in fact, policy or method which would alter the information given in the applica-tion, the applicant shall notify the Director of Public Welfare in writing thereof within 24 hours after such change.

I certify that the information provided in this Request for Permit to solicit is true and correct to the best of my knowledge.
CHOOSE DATE  
Date Name of Person Who Will Sign the Application