Form Rcg-32 - Charitable Games Event Workers Attendance List
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1
2Illinois Department of Revenue
RCG-32
Charitable Games Event Workers Attendance List
Read this information first
Form RCG-32 must be completed after each charitable games event your organization conducts and must be submitted with Form RCG-18,
Charitable Games Tax Return and Report, filed for the date(s) listed in Step 1.
Members, employees, or volunteers of your organization who participated in the management or operation of your charitable games event must
complete Step 2. If more than 26 individuals worked your event, additional Forms RCG-32 must be completed. Setting and cleaning up, selling
concessions or working in the kitchen, or providing security for persons or property does not constitute participation in the management or
operation of a charitable games event.
The president of the organization conducting the charitable games event must complete the certification in Step 3.
Step 1: Identify your organization and charitable games event dates
Organization name: ________________________________________
Event date(s): ____ / ____ / ________
____ / ____ / ________
Month
Day
Year
Month
Day
Year
Charitable games license number: CG - ________________
Complete the second date entry if your events were held consecutively.
Step 2: Complete the workers’ perjury statement
Under penalties of perjury, I certify that I worked a charitable games event for the organization on the date(s) identified in Step 1. I also certify
that I have not participated in the management or operation of more than 12 charitable games events within this calendar year; that I have not
received any remuneration or compensation directly or indirectly for participating in the management or operation of any charitable games event;
that I am not a professional gambler or have not been convicted of any felony within 10 years of the date of this certification or of any violation of
the Criminal Code of 1961, Article 28; and that I am not employed by or do not have any interest in any person, firm or corporation that holds a
charitable games provider’s or supplier’s license.
1 _______________________________________________
7 _______________________________________________
Worker’s name
Worker’s name
______ - ____ - ________
______ - ____ - ________
Social Security number
Social Security number
_______________________________________________
_______________________________________________
Worker’s signature
Date
Worker’s signature
Date
2 _______________________________________________
8 _______________________________________________
Worker’s name
Worker’s name
______ - ____ - ________
______ - ____ - ________
Social Security number
Social Security number
_______________________________________________
_______________________________________________
Worker’s signature
Date
Worker’s signature
Date
3 _______________________________________________
9 _______________________________________________
Worker’s name
Worker’s name
______ - ____ - ________
______ - ____ - ________
Social Security number
Social Security number
_______________________________________________
_______________________________________________
Worker’s signature
Date
Worker’s signature
Date
4 _______________________________________________ 10 _______________________________________________
Worker’s name
Worker’s name
______ - ____ - ________
______ - ____ - ________
Social Security number
Social Security number
_______________________________________________
_______________________________________________
Worker’s signature
Date
Worker’s signature
Date
5 _______________________________________________ 11 _______________________________________________
Worker’s name
Worker’s name
______ - ____ - ________
______ - ____ - ________
Social Security number
Social Security number
_______________________________________________
_______________________________________________
Worker’s signature
Date
Worker’s signature
Date
6 _______________________________________________ 12 _______________________________________________
Worker’s name
Worker’s name
______ - ____ - ________
______ - ____ - ________
Social Security number
Social Security number
_______________________________________________
_______________________________________________
Worker’s signature
Date
Worker’s signature
Date
RCG-32 front (R-01/14)
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