Form Rcg-2 - List Of Charitable Games Workers

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Illinois Department of Revenue
RCG-2
List of Charitable Games Workers
Read this information first
In order for the individuals listed in Step 3 to participate in the management or operation of your charitable games events, all requested
information must be complete, and we must receive this form at least 14 days prior to the earliest event date listed in Step 2. In addition, the
president and secretary listed on Form RCG-1, Charitable Games Application for License, must sign this form.
Step 1: Identify your organization
Organization name: ________________________________________
Charitable games license number: CG - ______________
Step 2: Identify the event dates
This charitable games workers list is for the following charitable games event dates:
____ / ____ / ________
____ / ____ / ________
____ / ____ / ________
____ / ____ / ________
Month
Day
Year
Month
Day
Year
Month
Day
Year
Month
Day
Year
____ / ____ / ________
____ / ____ / ________
____ / ____ / ________
____ / ____ / ________
Month
Day
Year
Month
Day
Year
Month
Day
Year
Month
Day
Year
Step 3: Identify those who will participate in your events
List below the members, employees, or volunteers of your organization who will participate in the management or operation of your charitable
games events. If more than 20 individuals will be participating in such activities, additional Forms RCG-2 must be completed. Setting up, cleaning
up, selling concessions, 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.
Note: The following individuals are ineligible to work charitable games events: professional gamblers, persons who have been convicted of a
felony within 10 years of the date your Form RCG-1, Charitable Games Application for License, was filed, persons who have been convicted of
any violation of Article 28 of the Criminal Code of 1961, or persons who are employed by or have any interest in any person, firm, or corporation
that holds a charitable games provider’s or supplier’s license.
1 _______________________________________________
5 _______________________________________________
Name
Name
_______________________________________________
_______________________________________________
Number and street
Number and street
_______________________________________________
_______________________________________________
City
State
ZIP
City
State
ZIP
______ - ____ - ________
____ / ____ / ________
______ - ____ - ________
____ / ____ / ________
Social Security number
Date of birth
Social Security number
Date of birth
2 _______________________________________________
6 _______________________________________________
Name
Name
_______________________________________________
_______________________________________________
Number and street
Number and street
_______________________________________________
_______________________________________________
City
State
ZIP
City
State
ZIP
______ - ____ - ________
____ / ____ / ________
______ - ____ - ________
____ / ____ / ________
Social Security number
Date of birth
Social Security number
Date of birth
3 _______________________________________________
7 _______________________________________________
Name
Name
_______________________________________________
_______________________________________________
Number and street
Number and street
_______________________________________________
_______________________________________________
City
State
ZIP
City
State
ZIP
______ - ____ - ________
____ / ____ / ________
______ - ____ - ________
____ / ____ / ________
Social Security number
Date of birth
Social Security number
Date of birth
4 _______________________________________________
8 _______________________________________________
Name
Name
_______________________________________________
_______________________________________________
Number and street
Number and street
_______________________________________________
_______________________________________________
City
State
ZIP
City
State
ZIP
______ - ____ - ________
____ / ____ / ________
______ - ____ - ________
____ / ____ / ________
Social Security number
Date of birth
Social Security number
Date of birth
RCG-2 front (R-01/14)

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