Fillable Printable Rb-3 Application For Bingo License
Fillable Printable Rb-3 Application For Bingo License
Rb-3 Application For Bingo License
RB-3 front (R-08/15)
Illinois Department of Revenue
Application for Bingo License
Register faster using MyTax Illinois, our online account management program, available on our website at tax.illinois.gov. If you have
questions, visit our website or contact us weekdays between 8:00 a.m. and 4:30 p.m. at 217 785-5864 or email at rev[email protected].
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, or persons participating in the management or operation of bingo who have been convicted
of a felony within the last 10 years or who have been convicted of a violation of Article 28 of the Criminal Code of 2012; and
• not compensate persons participating in the management or operation of bingo.
For more information about the laws, rules, and regulations governing the bingo license and tax act visit our website at tax.illinois.gov and
review the Bingo License Tax Act (230 ILCS 25/1 to 25/7) and 86 Ill. Admin. Code Part 430.
Step 1: Identify your organization
1 Federal employer identification number (FEIN)
FEIN: ______ - __________________
2 Organization name:
__________________________________________________
3 Primary or legal business address:
___________________________________________________
Street address - No PO Box number Apartment or suite number
___________________________________________________
City State ZIP
4 Mailing address if different from the address above:
___________________________________________________
In-care-of name
___________________________________________________
Street address or PO Box number Apartment or suite number
___________________________________________________
City State ZIP
Step 2: Identify your officers and the person in charge
8
Provide the following information for the organization’s officers and person in charge. If the officers in your organization change, you must
file Schedule REG-1-O. Note: One person listed below must sign the application.
a ____________________________ _______ - _____ - ________
President’s name Social Security number
________________________________________________________
Home address - No PO Box number City State ZIP
____ / ____ / ________ (______) ______ - ________
Date of birth Phone
b ____________________________ _______ - _____ - ________
Secretary’s name Social Security number
________________________________________________________
Home address - No PO Box number City State ZIP
____ / ____ / ________ (______) ______ - ________
Date of birth Phone
RB-3
5 Check the organization type that applies to you:
Corporation
S Corp (Subchapter S Corporation)
Not-for-profit organization
6 Charitable organizations applying for a new regular or limited
bingo license must provide the following:
• A copy of your organization’s bylaws and one of the following:
- Constitution,
- Charter, or
- Articles of incorporation; and
• Copy of meeting minutes from one month of the last five
years, or two years if you are chartered by a national
organization.
Note: If renewing your license, you do not have to provide the
above information.
7 Identify a contact person regarding your business.
Name: __________________________ Title: _____________
Phone: (______) ______ - ________ Ext.: __________
FAX: (______) ______ - ________
Email address: _____________________________________
This form is authorized as outlined under the tax or fee Act imposing the tax or fee
for which this form is filed. Disclosure of this information is required. Failure to provide
information may result in this form not being processed and may result in a penalty.
c ____________________________ _______ - _____ - ________
Treasurer’s name Social Security number
________________________________________________________
Home address - No PO Box number City State ZIP
____ / ____ / ________ (______) ______ - ________
Date of birth Phone
d ____________________________ _______ - _____ - ________
Person-in-charge’s name Social Security number
________________________________________________________
Home address - No PO Box number City State ZIP
____ / ____ / ________ (______) ______ - ________
Date of birth Phone
Use your 'Mouse' or the 'Tab key' to move through the fields and 'Mouse' or 'Space bar' to enable the checkboxes.
Step 3:
Type of license you are applying for - Check one
Regular - conduct bingo at the organization’s physical address on a weekly basis - $200 annual fee
What is the address where you will be conducting bingo?
Address:__________________________________________________________________________________________________________________________________________________
Street address - NO PO Box number City County State ZIP
Is this location owned or occupied by your organization or a unit of local government? ___ Yes ___ No
If no, enter the bingo provider of premises license number. BP-_____________
What day of the week will bingo be played?_____________________________
At what time will bingo begin and end?
_____:_____
a.m.
p.m.
to _____:_____
a.m.
p.m.
Hour Minute Hour Minute
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Special - have a regular bingo license and will hold events at your regular bingo location but on a day other than your regular day - No fee
A special permit allows you to have two such events per license for a maximum of five consecutive days per event. Provide the location
address, date, and time below
. I
f, at this time, you do not know when the events will be held you must submit the information on
Form RCG-1-E no less than 30 days prior to the event.
a First event:_____/_____/_____ to _____/_____/_____ b Second event:_____/_____/_____ to _____/_____/_____
Month Day Year Month Day Year Month Day Year Month Day Year
At what time will bingo begin and end: At what time will bingo begin and end:
_____ : _____
a.m.
p.m.
to _____ : _____
a.m.
p.m.
_____ : _____
a.m.
p.m.
to _____ : _____
a.m.
p.m.
Hour Minute Hour Minute Hour Minute Hour Minute
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Limited - conduct bingo no more than two times a year for a maximum of five consecutive days per event - $50 fee
Provide the location address, date, and time below. I
f, at this time, you do not know when the events will be held you must submit the
information on Form RCG-1-E no less than 30 days prior to the event.
a First event:_____/____/_____ to _____/_____/_____ b Second event:_____/_____/_____ to _____/_____/_____
Month Day Year Month Day Year Month Day Year Month Day Year
At what time will bingo begin and end: At what time will bingo begin and end:
____ : _____
a.m.
p.m.
to _____ : _____
a.m.
p.m.
_____ : _____
a.m.
p.m.
to _____ : _____
a.m.
p.m.
Hour Minute Hour Minute Hour Minute Hour Minute
_________________________________________________ _________________________________________________
Street address - No PO Box number Apartment or suite number Street address - No PO Box number Apartment or suite number
_________________________________________________ _________________________________________
City State ZIP City State ZIP
_________________________________________________
_________________________________________
County
County
Is this location owned or occupied by your organization Is this location owned or occupied by your organization
or a unit of local government? ___Yes ___ No or a unit of local government? ___ Yes ___ No
If no, enter the bingo provider of premises license number. If no, enter the bingo provider of premises license number.
BP-__________ BP-__________
Step 4: Pay your fee
- Check one - (
Note: The fee paid with your application is not refundable.)
If you are applying for a
One year regular bingo license, the fee is $200; One year limited bingo license, the fee is $50.
Make your check or money order payable to the “Illinois Department of Revenue.”
Step 5
: Sign below
Under the penalties of perjury, I state that I have examined this application and all attachments and other information required and to the best
of my knowledge, it is true, correct, and complete.
________________________________________________________________________________________________________________
Signature Printed name Date
RB-3 back (R-08/15)
Mail your form along with any attachments and payment to: OFFICE OF BINGO AND CHARITABLE GAMES 3-215
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19480
SPRINGFIELD IL 62794-9480
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