RAFFLE LICENSE APPLICATION

Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Organization Name
Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is mailing address same as Organization address?
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Check type of not-for-profit organization (must be in existence for a period of five years)
How long has the organization been in existence?
Place of incorporation
Date of incorporation

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Number of members in good standing
President/Chairperson

First NameLast Name
President/Chairperson Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
President/Chairperson Email
example@example.com
President/Chairperson Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Raffle Manager

First NameLast Name
Raffle Manager Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Raffle Manager Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Raffle Manager Email
example@example.com
Designated member(s) responsible for conduct and operation of raffle (use Add Row button to add additional lines, if needed)
License delivery option (check all that apply)
Email for Electronic Mail:
example@example.com
Raffle Type:
Date(s) for raffle ticket sales (include days of the week):
Location of ticket sales:
Name and address of location for determining winners:
Date(s) for determining winners (include days of the week):
Total retail value of all prizes (maximum prize amount $250,000.00):
Entry Format Example: 250,000.00
Maximum retail value of each prize:
Entry Format Example: 250,000.00
Maximum price charged of each ticket (chance) sold:retail value of each prize:
Entry Format Example: 250,000.00
Is this a queen of hearts raffle?
§ 132.38 Fidelity Bond Required
All operations of and the conduct of raffles as provided for in this subchapter shall be under the supervision of a single manager designated by the organization. Such manager shall give a Fidelity bond in the sum of $165,000 or two times the aggregate value of prizes, whichever is less, in favor of the licensee conditioned upon his honesty in the performance of his duties. The bond shall provide that notice shall be given in writing to the Village of Tinley Park not less than thirty (30) days prior to cancellation. Bonds as provided for in this section may be waived provided the license issued for such raffle shall contain a waiver provision and shall be approved only by unanimous vote of the members of the licensed organization.
Upload Fidelity Bond/Bond Statement

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“The undersigned attest that the above-named organization is an organized not-for-profit under the law of the State of Illinois and has been continuously in existence for five (5) years, preceding date of this application, and that during this entire five (5) year period preceding date of application, it has maintained a bona fide membership actively engaged in carrying out its objectives. The undersigned do hereby state under penalties of perjury that all statements in the foregoing application are true and correct; that the officers, operators and workers of the game are bona fide members of the sponsoring organization and are all of good moral character and have not been convicted of a felony; that if a license is granted hereunder, the undersigned will be responsible for the conduct of the games in accordance with the provisions of the laws of the State of Illinois and this jurisdiction governing the conduct of such games.”
Name of Organization:
Executive Director

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

§ 132.38 Fidelity Bond Required