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2. Organization Name
4. Organization Address
6. City
7. State
8. Zip Code
10. Type of Organization
11. Phone Number
13. Length of Time in Existence
14. Total Membership
16. Place of Incorporation
17. Date of Incorporation
    Date of Incorporation
21. Presiding Officer Name
22. Presiding Officer Home Phone Number
24. Presiding Officer Address
26. City
27. State
28. Zip Code
32. Raffle Manager Name
33. Raffle Manager Home Phone Number
35. Raffle Manager Address
37. City
38. State
39. Zip Code
41. Date Of Raffle Sales And Locations Where Sales Are To Be Made
43. Date
    Date
44. Location
46. Date
    Date
47. Location
49. Date
    Date
50. Location
52. Location of Drawing
53. Date of Drawing for Winner/Winners
    Date of Drawing for Winner/Winners

    Date of Drawing for Winner/Winners
55. Total Retail Value of Each Prize
56. Maximum Charge for Each Chance
58. Maximum Retail Value of Each Prize
60. The undersigned attest that the above-named organization is organized for not-for-profit under the law of the State of Illinois. The undersigned do hereby state under penalties of perjury that all statements in the foregoing application are true and correct; that the officers, operators and workers of the raffle are bona fide members of the sponsoring organization and are all of good moral character and have not been convicted of a felony; that if a license is granted hereunder, the undersigned will be responsible for the conduct of the raffle in accordance with the provisions of the laws of the State of Illinois and this jurisdiction governing the conduct of such raffle.
62. Presiding Officer
63. Secretary
64. Date
    Date
66. Fee: $5
68. Date Paid
    Date Paid
69. Date License Issued
    Date License Issued
70. License Number
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72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit

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