INSTRUCTIONS FOR VIDEO GAMING LOCATION LICENSE APPLICATION

WARNING

BY FILING THIS APPLICATION, APPLICANT ACCEPTS ANY RISK OF ADVERSE PUBLIC NOTICE, EMBARRASSMENT, CRITICISM, OR OTHER ACTION, OR FINANCIAL LOSS WHICH MAY RESULT FROM ACTION TAKEN OR NOT TAKEN WITH RESPECT TO THE APPLICATION, AND EXPRESSLY WAIVES ANY CLAIM FOR DAMAGES AS A RESULT THEREOF. INFORMATION NOT REQUESTED IN THIS FORM OR IN ADDITION TO THAT PROVIDED IN RESPONSE TO THIS FORM MAY BE REQUESTED.

Read the entire Form before responding to the questions.

There are 10 parts to this application that must be completed. A few documents will need to be scanned and electronically uploaded as part of this application, so you will need access to a scanner.

All Applicants are advised that this application is an official document. Applicant should respond to the questions contained herein to the Best of its Knowledge. Do not misstate or omit any material fact(s) as each statement made herein is subject to verification. ANY misrepresentation, failure to reveal information or omission is grounds for denial of the Application. “A person who knowingly makes a false statement on an application is guilty of a Class A misdemeanor.” 230 ILCS 10/9(f).

Applicant is under a continuing duty to disclose promptly any changes in the information provided in the Application and additional information and materials submitted to the Illinois Gaming Board, including any changes in the ownership of the location. The duty to make such additional disclosures shall continue throughout any period of licensure granted by the Illinois Gaming Board.

The Illinois Gaming Board will send notice if the Applicant is found suitable for licensing. Upon receipt of this notice, the Illinois Gaming Board will provide Applicant with instructions to submit an annual license fee of $100 to the Illinois Gaming Board (DO NOT SEND CASH). Your license will be issued only if you are found suitable and the annual license fee is properly received.