Fill a Valid Rb 3 Illinois Form

Illinois Department of Revenue

RB-3 Application for Bingo License

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Read this information first

To qualify for a license to conduct bingo games, your organization must

•be not-for-profit;

•have been organized and in existence in Illinois for at least the past five years or affiliated and chartered with a national organization for two years and have had members carrying out the organization’s goals during either period;

•not have any officers, directors, employees, or persons participating in the management or operation of bingo who have been convicted of a felony within the last 10 years or who have been convicted of a violation of Article 28 of the Criminal Code of 2012; and

•not compensate persons participating in the management or operation of bingo.

For more information about the laws, rules, and regulations governing the bingo license and tax act visit our website at tax.illinois.gov and review the Bingo License Tax Act (230 ILCS 25/1 to 25/7) and 86 Ill. Admin. Code Part 430.

Step 2: Identify your officers and the person in charge

8Provide the following information for the organization’s officers and person in charge. If the officers in your organization change, you must file Schedule REG-1-O. Note: One person listed below must sign the application.

This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this information is required. Failure to provide information may result in this form not being processed and may result in a penalty.

RB-3 front (R-08/15)

Step 3: Type of license you are applying for - Check one

Regular - conduct bingo at the organization’s physical address on a weekly basis - $200 annual fee

What is the address where you will be conducting bingo?

Address:__________________________________________________________________________________________________________________________________________________

Street address - NO PO Box numberCityCountyStateZIP

Special - have a regular bingo license and will hold events at your regular bingo location but on a day other than your regular day - No fee A special permit allows you to have two such events per license for a maximum of five consecutive days per event. Provide the location address, date, and time below. If, at this time, you do not know when the events will be held you must submit the information on

Form RCG-1-E no less than 30 days prior to the event.

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Limited - conduct bingo no more than two times a year for a maximum of five consecutive days per event - $50 fee

Provide the location address, date, and time below. If, at this time, you do not know when the events will be held you must submit the information on Form RCG-1-E no less than 30 days prior to the event.

Street address - No PO Box numberApartment or suite numberStreet address - No PO Box numberApartment or suite number

Step 4: Pay your fee - Check one - (Note: The fee paid with your application is not refundable.)

If you are applying for a One year regular bingo license, the fee is $200; One year limited bingo license, the fee is $50.

Make your check or money order payable to the “Illinois Department of Revenue.”

Step 5: Sign below

Under the penalties of perjury, I state that I have examined this application and all attachments and other information required and to the best of my knowledge, it is true, correct, and complete.

________________________________________________________________________________________________________________

SignaturePrinted nameDate

RB-3 back (R-08/15)