Fillable Form 5368 Fee Waiver Application (City Of Huntington Park)

Fill Online, Printable, Fillable, Blank Form 5368 Fee Waiver Application (City Of Huntington Park) Form

Use Fill to complete blank online CITY OF HUNTINGTON PARK (CA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 5368 Fee Waiver Application (City Of Huntington Park)

On average this form takes 25 minutes to complete

The Form 5368 Fee Waiver Application (City Of Huntington Park) form is 3 pages long and contains:

  • 1 signature
  • 30 check-boxes
  • 81 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City Of Huntington Park

BROWSE CITY OF HUNTINGTON PARK (CA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Facility Fee Waiver Application
Please read and carefully complete the following application. Failure to provide accurate information
may result in a delay or denial of your request for a fee waiver. Please attach a copy of your Facility
Rental Application to this form and return to the Department of Parks and Recreation.
Submission of this application does not guarantee rental of facility.
A. CONTACT INFORMATION
Name of Group/Organization
Is this a non-profit organization
YES NO Tax ID # (Non-profit only)
Applicant Name/Person Responsible Title
Cell Phone Alternate Phone
E-mail Address
Address City State Zip
B. FACILITY INFORMATION
Indicate the specific facility or facilities for which you are requesting a fee waiver
FREEDOM PARK RECREATION CENTER FREEDOM PARK ATHLETIC FIELD
HUNTINGTON PARK COMMUNITY CENTER KEVIN DE LEON SOCCER FIELD
RAUL R. PEREZ MEMORIAL PARK RECREATION CENTER RAUL R. PEREZ MEMORIAL PARK ATHLETIC FIELD
ROBERT H. KELLER PARK ROBERT H. KELLER PARK PICNIC SHELTER
SALT LAKE PARK CLUB ROOM # SALT LAKE PARK BALL FIELD #
SALT LAKE PARK BATTING CAGES SALT LAKE PARK GYMNASIUM
SALT LAKE PARK LOUNGE SALT LAKE PARK SOCIAL HALL
SALT LAKE PARK SOCCER SQUARE SENIOR PARK
OTHER
C. EVENT INFORMATION
1. Event Description (provide a detailed description of the event, its purpose, and the activities that will take place).
Anticipated Daily Attendance Anticipated Total Attendance
2. Is your organization an official non-profit organization 501(c)3?
Yes No
• If yes, list the non-profit tax ID number
3. Will you be charging a fee for this event? Yes No
• If yes, list all fees
3401 E. Florence Avenue
Huntington Park, CA 90255
www.hpca.gov
(323) 582-6218
4. Will the event be open to the public? Yes No
5. Is this event a fundraiser?
Yes No
D. EVENT DATES AND TIMES
Set-up Date(s) Set-up Start Time
Event Start Date(s) Event Start Time
Event End Date Event End Time
Breakdown Date(s) Breakdown End Time
E. FEE WAIVER INFORMATION
Please complete
ONLY
the section which applies to your event (Intergovernmental Cooperation, Non-Profit, Private Business or
Organization or City Sponsored Event)
Intergovernmental Cooperation (Applicant is a government agency)
Name of Specific Department/Unit Responsible for Event
How does this event benefit the residents of Huntington Park?
Why is it necessary to hold this event at a City facility?
Non-Profit Organization
Private Business, Organization or Individual
*Non-profit organization will be required to provide verification of tax-exempt status.
Do you provide a service solely to the residents of Huntington Park? YES NO
Indicate the negative impact or financial hardship that the normal facility fees would create for your event or agency.
You may attach a budget or financial statement for your organization to clarify the reason for your fee waiver request.
3401 E. Florence Avenue
Huntington Park, CA 90255
www.hpca.gov
(323) 582-6218
What significant value or benefit will your event provide to Huntington Park residents?
City-Sponsored Event
See the Park Facility Use Fee Waiver Policy for details about City-sponsored event requests.
Does your organization have, or is it in the process of receiving, a tax-exempt status? YES NO
Explain why the City should be a co-sponsor of your event:
F. FEE WAIVER REQUEST
Are you requesting a 100% waiver of all applicable rental fees? YES NO
If “NO” which fees are you requesting to be waived? (Note: refundable security deposit may not be waived)
Facility Fee $
Personnel (Staffing) $
Janitorial $
Equipment/Material $
G. REVIEW PROCESS
You will be notified within 5 business days of submission of your application whether your request has been denied or will be
referred to the City Manager, PARC Commission, and/or City Council for review. Fee waiver requests less than $250 in indirect
fees may be considered by the City Manager, PARC Commission and/or City Council. For additional details, review the Park
Facility Use Fee Waiver Policy.
H. Ap
plicant Signature
I understand and agree to abide by all of the Facility Fee Waiver and Facility Rental regulations of the City of Huntington Park
and any other conditions imposed for the event requested. I certify that all statements made on this application are true and
complete to the best of my knowledge. I understand that any false statement may result in denial of the requested permit or
revocation of any issued permit.
SIGNATURE DATE
---STAFF USE ONLY---
APPLICATION RECEIVED BY DATE RECEIVED APPLICATION APPROVED BY
ALL CRITERIA FOR FEE WAIVER HAS BEEN MET? YES NO FEE WAIVER STATUS APPROVED DENIED CONDITIONAL
TOTAL FEES WAIVED $ FACILITY FEES DUE LIGHT FEES DUE
STAFF FEES DUE CHALKING FEES DUE TOTAL DUE
APPROVED BY
3401 E. Florence Avenue Huntington Park, CA 90255 www.hpca.gov (323) 582-6218
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 5368 Fee Waiver Application (City Of Huntington Park)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 15 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document