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Get IL DoR RB-3 2015-2024

This form is authorized as outlined by the Bingo License and Tax Act. Disclosure of this information is REQUIRED. Failure to provide information could result in this form not being processed. This form has been approved by the Forms Management Center. IL-492-1359 Step 3 continued Tell us about your bingo event 6 What day of the week will bingo be played 9 Estimate the number of people who will play bingo weekly. Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes. Illinois Department of Revenue RB-3 Bingo Application for License License no. License issued Do not write above this line. Read this information first To qualify for a license to conduct bingo games your organization must be not-for-profit have been organized and in existence in Illinois for at least the past five years or affiliated and chartered with a national organization for two years and have had members carrying out the organization s goals during either period not have any officers directors employees workers or operators of bingo who have been convicted of a felony or who have been convicted of a gambling offense not compensate operators or workers who participate in the management or operation of bingo and post a surety bond in the amount of the anticipated average quarterly tax liability if you are a new applicant. Step 1 Identify your organization Organization name List all of the following numbers that your organization has been assigned* Physical address Number and street FEIN - City State County ZIP IBT number - Telephone number Charitable games license no. Mailing address Pull tabs license no. Step 2 Tell us about your organization 1 Check the type of your nonprofit organization* charitable religious educational senior citizen fraternal veterans labor youth athletic If this is the first time you are applying for this license attach a copy of your bylaws and constitution or charter. 3 How long has your organization had members carrying out its goals 4 Is your organization incorporated yes no If yes in which state and on what date was it incorporated State copy of the articles of incorporation* 2 How many members does your organization have 1 Where will bingo be played City state ZIP 4 What are the two time periods bingo will be played First time period Month 2 Do you own or lease the premises where bingo will be played own lease If you lease the premises specifically for the conduct of bingo games attach a copy of your lease agreement. Day Hour 3 Will you conduct bingo events more than twice a year If yes go to Item 6 on the back. You are applying for a regular bingo license. If no go to Item 4. You are applying for a limited bingo license. RB-3 Front R-1/95 A. M. P. M. Minute Year Second time period // to // If the provider supplies services or products that are not included in the lease send us a list of the items and their cost with this application* Write the provider s license number. Note If the last date is not known at this time you must let us know the exact date 30 days before the event.

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