Form Rcg-9 - Application Or Annual Report For Charitable Game Equipment Ownership Permit

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Illinois Department of Revenue
RCG-9
Application or Annual Report for
Charitable Game Equipment Ownership Permit
Read this information first
If you are a new applicant for a charitable games license
If you are not renewing your charitable games license but
and you answered “yes” to Step 2, Item 6, on Form RCG-1,
own charitable games equipment, check “annual report” in
Charitable Game Application for License, check “application”
Step 1, Item 3, below and file this form by January 30.
in Step 1, Item 3, below and file this form with Form RCG-1.
Mail your completed form (and payment if you answer “no” to
If you are renewing your charitable games license and own
Step 2, Item 2) to:
charitable game equipment, file this form with Form RCG-1. If
OFFICE OF BINGO AND CHARITABLE GAMES
you already have been issued a charitable game equipment
ILLINOIS DEPARTMENT OF REVENUE
ownership permit, check “annual report” in Step 1, Item 3,
PO BOX 19480
below. If you answered “yes” to Step 2, Item 6, on
SPRINGFIELD IL 62794-9480
Form RCG-1, and do not have a charitable game equipment
If you have questions, call our Springfield office weekdays
ownership permit, check “application” in Step 1, Item 3, below.
between 8:00 a.m. and 4:30 p.m. at 217 524-4164.
Step 1: Identify your organization
1
3
Organization’s name ______________________________
Are you applying for a charitable game equipment
ownership permit or filing an annual report of your inventory?
2
License no.: CG - __________________
application
annual report
(if you have been assigned one)
Step 2: Tell us about your equipment and permit
1
List all equipment your organization owns that is used in playing charitable games. Attach additional sheets if necessary.
Equipment
Quantity
________________________________________________________________
________________________________
________________________________________________________________
________________________________
________________________________________________________________
________________________________
________________________________________________________________
________________________________
________________________________________________________________
________________________________
________________________________________________________________
________________________________
________________________________________________________________
________________________________
________________________________________________________________
________________________________
2
If you checked “annual report” in Step 1, Item 3, skip to Step 3.
If you checked “application” in Step 1, Item 3, have you paid the onetime fee for this permit?
yes
no
If “no,” make your check for $50 payable to “Illinois Department of Revenue.”
Step 3: Sign below
Under penalties of perjury, I state that I have examined this form and that it is true, correct, and complete. I certify that each
piece of equipment listed in Step 2 has the name of the organization permanently affixed to it in a clearly visible location. I further
certify that all chips either contain the organization’s name or are monogrammed with a logo that is registered with the Illinois
Department of Revenue.
_______________________________________________________
President’s signature
Date
This form is authorized by the Charitable Games Act. Disclosure of this information is REQUIRED. Failure to comply
RCG-9 (R-7/97)
may result in a penalty. This form has been approved by the Forms Management Center.
IL-492-2145
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