Charitable Solicitation License Application

License Application for - Charitable Solicitation

MUNICIPAL CODE SECTION – 4-55
South Bend Municipal Code: Section 4-55

Definition:

Charitable solicitation includes the request for financial assistance in connection with philanthropic purposes as well as the sale or attempted sale of items or services in connection with philanthropic purposes or organizations.

NOTE:
See South Bend Municipal Code for solicitations not requiring a permit.

General Instructions and Application Process:
1. Assemble all required information and materials before filing application.
2. Thoroughly review all applicable Municipal Code Sections listed above.
3. Licenses expire January 31.
4. Add 10% to license fee for renewal after January 31.
5. You are responsible for $5.00 license application fee payable to City of South Bend for this application to be valid. You may pay in-person at City Hall or by calling the Business Licensing Manager to pay over the phone at 574-235-5912
6. License fee payable to City of South Bend due at issuance - $45.00.
Required Information and Materials:
1. Applicant, organization, purpose, amount, manner and disposition information.
2. Statement disclaiming City endorsement.
3. Statement of charitable purpose and percent of funds raised to be used thus.
4. If a professional fund raiser consultant and/or a professional solicitor is to be
  used, his/her name and address, written proof of registration with the State of Indiana pursuant to IC 23-7-8-1, and a copy o the contract between professional and the applicant must be provided.
Application Process:
1. Submit Application with $5.00 Processing Fee at least 30 days before desired permit date.
2. Controller Denies or Approves License.
3. License issued on payment of fee.
4. License Holder may solicit only with permit in hand, complying with receipt requirements.
5. Submit report and financial statement to Controller within sixty (60) days after solicitation complete.
Questions?

For all municipal business license questions, contact:

City of South Bend

Department of Community Investment

215 S. Dr. Martin Luther King Jr. Blvd.

Suite 500
South Bend, Indiana 46601

Email: BusinessLicense@southbendin.gov

Phone: 574.235.5912

Fax: 574.235.9021

Application Type
Is this application pertaining to a new business or are you renewing your existing permit?*

New PermitRenew Permit
Organization Information
Name of applying organization*
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does Mailing address differ from Property Address?*

Yes, different addressNo, Same address
Organization Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your Organization a Corporation or Partnership?*

YesNo
List names, titles, phone numbers and addresses of all principal officers*
Charitable Solicitation Information
Solicitation Period will begin on*

MonthDayYear
Solicitation Period will end on*

MonthDayYear
Describe the purpose for which the Solicitation is to be made*
Outline the method(s) of solicitation to be used*
Describe the kind and extent of charitable work being done by the organization*
Will a professional fund-raising consultant or professional solicitor be used?*

YesNo
Professional's Name*

First NameLast Name
Professional's Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State of Indiana Consultant / Solicitor Registration*

Cancelof
Contract between Consultant/Solicitor and Applicant*

Cancelof
Financial Information
Estimated total amount of funds to be raised*

Please input your expenses*

Rows	Expenses
Salaries/Commissions
Merchandise/Entertainment
Promoter Fees
Printing
Rent
Office Expenses
Other
Total Expenses

Estimated percentage of solicited funds to be used directly for charitable work*
Estimated percentage of solicited funds that will be retained in the City*
Please input names and addresses of organization(s) receiving disbursements from the proposed solicitation*
Personal Data
Applicant 1's Legal Name*

First NameMiddle NameLast Name
Applicant 1's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant 1's Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant 1's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant 1's Email*
example@example.com
Applicant 1's Position with Organization*
Applicant 1's Date of Birth*

MonthDayYear
Applicant 1's Gender
Last Four Digits of Applicant's Social Security Number*
Applicant 1's Race*
Are there any other applicants for this license?*

NoYes, one moreYes, two more
Applicant 2's Legal Name*

First NameMiddle NameLast Name
Applicant 2's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant 2's Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant 2's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant 2's Email*
example@example.com
Applicant 2's Position with Organization*
Applicant 2's Date of Birth*

MonthDayYear
Applicant 2's Gender*
Last Four Digits of Applicant's Social Security Number*
Applicant 2's Race*
Applicant 3's Legal Name*

First NameMiddle NameLast Name
Applicant 3's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant 3's Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant 3's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant 3's Email*
example@example.com
Applicant 3's Position with Organization*
Applicant 3's Date of Birth*

MonthDayYear
Applicant 3's Gender
Last Four Digits of Applicant's Social Security Number*
Applicant 3's Race*
Signature
I, hereby, certify and affirm that all the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I understand that the completed application must be filed no less than thirty (30) days before the proposed beginning date of the solicitation. I have read and understand the regulations of the Charitable Solicitations license found in the City of South Bend Municipal Code, Section 4-55. Finally, I understand that, if registration and a permit are granted, it will not be used or represented in any way or manner, such an endorsement by the City of South Bend or by any Department or Officer thereof.
Electronic Signature*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

License Application for - Charitable Solicitation

Definition:

General Instructions and Application Process:

Required Information and Materials:

Application Process:

Questions?

Application Type

Organization Information

Charitable Solicitation Information

Financial Information

Personal Data

Signature