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Organization
Application Name of Applicant Organization _______________________________________________ Address (Permanent) _______________________________________________________ Local Address (if different) ___________________________________________________ Telephone Number: Local ____________ Permanent ____________ Is the Organization Non-Profit? Yes ___ No___ Evidence of Non-Profit Nature ________________________________________________ Dates of Solicitation: From: ____________ To: ____________ Description of Activities to be Conducted: ________________________________________ ________________________________________________________________________ ________________________________________________________________________ Ranking Officer of Organization: Name ___________________ Title _________________ Person in Charge of Solicitation: Name ___________________ Title _________________ Address _______________________________ Tel # ________________ Date of Birth _______________ Place of Birth __________________________ Names
of ALL PERSONS who will be going from house-to-house (attach "Application
for Solicitor's Badge" form for each person named): I certify that the information above is true and correct to the best of my knowledge. ______________________________________
Date ___________ If Non-Profit, I certify that no person participating in this solicitation has received or will receive compensation for his or her conduct. ______________________________________
Date ___________ |