Macon County, Illinois Raffle and/or Poker Run License Application | For official use only Received and Filed |
License Sought ___ Raffle ___Poker Run ___Both |
Applicant Information
Name of Organization: | ||||||
Organization Address: (if no specific address, list address of organization’s presiding officer) | ||||||
Organization’s Telephone: | ||||||
Type of Organization | Religious | Charitable | Fraternal | |||
Educational | Veterans | Labor | ||||
Other | ||||||
How long has the organization been in existence? (in years) | ||||||
Raffles Only | ||||||
Area or areas within unincorporated Macon County in which raffle chances will be sold or issued | ||||||
The time period during which raffle chances will be sold or issued (not longer than one year) | ||||||
The time of determination of winning chances | ||||||
The location or locations at which winning chances will be determined | ||||||
Poker Runs Only | ||||||
The location where the poker run will conclude and where the prize or prizes will be awarded | ||||||
The time period during which poker run or runs will be conducted (not longer than one year) | ||||||
Raffle Prize Value (Do not complete if your event is a combination raffle/poker run event.) | ||||
Estimated total vale of all prizes which may be awarded in a single raffle (check one box) | Less than or equal to $2,500 | More than $2,500 | ||
Fidelity Bond All applicants must attach a copy of a fidelity bond in an amount equal to the estimated aggregate retail value of all prizes to be awarded. Alternatively, applicants may submit Certificate of Unanimous Approval of Raffle Bond Waiver. | ||||
Attestation The undersigned attest that the organization named above is a not-for-profit organization. | ||||
Presiding Officer of Organization | ||||
Secretary of Organization | ||||
Subscribed and sworn to before me this | ||||
day of , 20 . | ||||
NOTARY PUBLIC | ||||
(Do not write below this line. For Official Use Only.) | ||||
Fee collected | Poker run license only $25 | |||
(circle one) | Raffle license only (estimated total value of prizes $2,500 or less) $30 | |||
Raffle license only (estimated total value of prizes greater than $2,500) $31 | ||||
Combined Poker Run/Raffle $31 | ||||
Application Approved: | ||||
Application Denied: If denied, applicant may appeal denial to the Macon County Board by initialing here. | ||||
(Ord. O-118-1-15, passed 1-8-2015; Ord. 121-04-16, passed 4-14-2016)