The city shall provide each applicant a form which complies substantially with the following form:
APPLICATION FOR PERMIT TO SOLICIT UNDER SOLICITATIONS ORDINANCE |
(1) Name of person or organization |
Address of headquarters of applicant |
(2) Names of applicant's principal officers and managers (if any): |
President Address |
Vice-President Address |
Secretary Address |
Manager Address |
Directors: Address |
Address |
Address |
(3) Have you attached to this application a true and correct copy of the resolution (if any) authorizing the applicant to undertake the proposed solicitation covered by the application? __________ Yes ___________ No |
(4) The purpose for which the solicitation is to be made is the following: __________________________________________________ (Attach a statement if more space is needed.) |
(5) The total amount of funds to be raised is |
(6) The receipts from the solicitation will be used, or disposed of as follows: (Explain in detail on attached statement.) |
(7) The need for the contributions to be solicited is as follows: (This statement must be specific, supported by reasons and, if available, figures — an attached statement can be used.) |
(8) The following persons will disburse the receipts of this solicitation: (Give name, address and title) |
(9) The following persons will be in direct charge of conducting the solicitation: (Give name, address and title) |
(10) The following promoters are connected, or will be connected with the solicitations: (Give name, address and title) |
(11) The method or methods to be used in conducting the solicitations are as follows: (Explain on attached sheet, if necessary) |
(12) The proposed dates for the beginning and ending of the solicitations are: |
Date begin _________________, 20___ , through ______________________, 20 ____. |
(13) The estimated total cost of the entire solicitation campaign is . |
(14) The wages, fees, commissions, expenses or emoluments to be expended or paid to any person in connection with such solicitation, and the name and addresses of all such persons are the following: (Give name, address, title and amount) |
(15) Have you attached to this application a statement giving the terms and contents of all agreements, both oral and written, with all agents, solicitors, promoters, managers or conductors in connection with the proposed solicitation covered in this application? ___________ Yes ____________ No |
(16) Have you attached a financial statement for the last preceding fiscal year of all funds collected for charitable purposes by the applicant, giving the amount of money raised, together with the cost of raising it and the final distribution thereof: ____________ Yes _______________ No |
(17) A full statement of the character and extent of the charitable work being done by the applicant with the City of Crossville is as follows: (Explain on attached sheet if more space is needed) |
(18) Will the actual cost of the solicitation exceed 25% of the total amount to be raised? _____________ Yes ______________ No |
(19) Does applicant certify that if a permit is granted, it will not be used or represented in any way as an endorsement of the City of Crossville or by any department or officer thereof? ______________ Yes _________________ No |
(20) The following is additional information believed by applicant to be useful to the Board in determining the kind and character of the proposed solicitation: |
(21) Is applicant a non-profit exempt organization under § 501(c)(3) of the Internal Revenue Code of 1954? ______________ Yes ______________ No |
All of the above statements are true to the best of my knowledge, information and belief. |
Signed by: |
Subscribed and sworn to before me, this __________________________ day of ______________________, 20 ______. |
Notary Public |
My commission expires: |
(1989 Code, § 9-306)