Video Gaming Application/Renewal Village of Bishop Hill

Video Gaming License Renewal.pdf

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VILLAGE OF BISHOP HILL VIDEO GAMING LICENSE APPLICATION/RENEWAL

Please submit this application along with a copy of your valid Illinois Gaming License, a copy of your valid Illinois Liquor License, a Village of Bishop Hill Liquor License application, copy of the Village of Bishop Hill Liquor license, and a copy of your paid Insurance. Please submit all these to the Village of Bishop Hill Clerk, by the annual renewal date of May 31 of each year. 

There is a $100 per machine charge for each license renewal.

The undersigned hereby certifies (certify) to the following facts:

1.     Name of Applicant(s):   ________________________________________________________________________________

2.     Address for which license is sought: ___________________________________________________

3.     Number of Video Gaming terminals to be operated: ______________________________________

4.     Type of Video Gaming terminals to be operated: _________________________________________

5.     Name of Licensed Video Gaming Terminal Operator: ______________________________________

_________________________________________________________________________________

6.     Have you made application for a similar license for premises other than described in this

location? _________. If so, give date, location of premises and disposition of the application:

_________________________________________________________________________________

7.     Has any license previously issued to you by State, Federal, or Local authorities been revoked?

_________. If so, state reasons therefore and date of revocation: ___________________________

_________________________________________________________________________________

8.     Structural and aesthetic improvements that will be made to the building and property in the

next year: ________________________________________________________________________

_________________________________________________________________________________

Date: ____________________________________                                      PAID: _________________________

Signature: _______________________________________                                      _________________________

Print Name: ______________________________________                                     _________________________