1

Date

 *

Date

2

City of Olathe Utility Account Number 

 *

City of Olathe Utility Account Number

3

Name of Organization

 *

Name of Organization

4

Responsible Party Name

 *

Responsible Party Name

5

Address

 *

Address

6

Phone Number

 *

Phone Numberext.

7

EIN Number

 *

EIN Number

8

Please attach an original copy of the 501(c)3 Letter of Determination

 *

Please attach an original copy of the 501(c)3 Letter of Determination Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

9

Please attach proof of ownership of the property or a copy of the current lease agreement.

 *

Please attach proof of ownership of the property or a copy of the current lease agreement. Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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