Form ADR201 "Racing Division License Application / Terms and Conditions" - Arizona

What Is Form ADR201?

This is a legal form that was released by the Arizona Department of Gaming - Division of Racing - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2016;
  • The latest edition provided by the Arizona Department of Gaming - Division of Racing;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ADR201 by clicking the link below or browse more documents and templates provided by the Arizona Department of Gaming - Division of Racing.

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Download Form ADR201 "Racing Division License Application / Terms and Conditions" - Arizona

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ARIZONA DEPARTMENT OF GAMING - RACING DIVISION
LICENSE APPLICATION INSTRUCTIONS
• Submit a complete application. Signature required on page 4. BE SURE TO INCLUDE COPY OF GOVERNMENT PICTURE I.D.
• Submit two (2) fingerprint cards* and a check for $22.00 (fingerprint processing fee). Persons under 18 years of age do not require prints.
*FINGERPRINTS MUST BE ON FD-258 CARDS ONLY. NO CANADIAN FINGERPRINT CARDS WILL BE ACCEPTED.
• The Division of Racing does NOT participate in reciprocity with other racing jurisdictions.
• National Racing Compact members do not need to submit fingerprints.
• Submit CASH, CASHIER’S CHECK or MONEY ORDER in U.S. dollars only payable to: ARIZONA DEPARTMENT OF GAMING, to cover the licensing fee(s) and
fingerprint processing.
NO PERSONAL CHECKS ACCEPTED.
ARIZONA STATEMENT OF CITIZENSHIP and ALIEN STATUS
BY APPLICANTS FOR STATE PUBLIC BENEFITS – Professional and Commercial License
Qualified Alien status
An alien lawfully admitted for permanent residence under the Immigration and Nationality Act (INA).
An alien who is granted asylum under § 208 of the INA.
A refugee admitted to the United States under § 207 of the INA.
An alien paroled into the United States for at least one year under § 212(d)(5) of the INA.
An alien whose deportation is being withheld under § 243(h) of the INA.
An alien granted conditional entry under § 203(a)(7) of the INA as in effect prior to April 1, 1980.
An alien who is a Cuban or Haitian entrant (as defined in § 501(e) of the Refugee Education Assistance Act of 1980.)
An alien who is, or whose child or child’s parent is a “battered alien” or an alien subjected to extreme cruelty in the United States.
Nonimmigrant status
A non immigrant under the Immigration & Nationality Act (8 USC § 1101 et seq). Non immigrants are persons who have temporary status for a specific purpose. (See 8
USC § 1101(a)(15).
Alien Paroled into the United States for less than One Year under § 212(d)(5) of the INA.
Other Persons
A nonimmigrant whose visa for entry is related to employment in the United States.
A citizen of a freely associated state, if § 141 of the applicable compact of free association approved in Public Law 99-239 or 99-658 (or a successor provision) is in effect.
(Freely Associated States include Republic of the Marshall Islands, Republic of Palau and the Federate States of Micronesia, 48 USC § 1901 et seq)
A foreign national not physically present in the United States
Otherwise Lawfully Present
A person not described in any of the above categories who is otherwise lawfully present in the United States.
• Submit one (1) of the following documents in support of your declaration. PROVIDE A GOVERNMENT PICTURE ID.
• EXCEPTIONS: Applicants who have applied through the National Racing Compact; Applicants for a temporary license who will provide documentation per A.R.S.5-
107.01(f) or Applicants who are citizens of a foreign country & not physically in the U.S.
An Arizona driver license issued after 1996 or an Arizona nonoperating identification license.
A driver license issued by a state that verifies lawful presence in the United States. (The following states do not verify, and therefore are not acceptable:
Illinois, Maryland, New Mexico, Utah and Washington. Washington verifies only for credentials labeled as “Enhanced.”)
Enhanced Driver License or ID Card issued by another state, territory or possession of the U.S.
E-Verification issued by the Department of Homeland Security verifying employment eligibility.
A Permanent Resident Card (green card)
A birth certificate or delayed birth certificate issued in any state, territory or possession of the U.S.
A United States certificate of birth abroad.
A United States passport or a foreign passport with a United States visa.
An I-94 form with a photograph.
Employment Authorization Card issued by the United States Citizenship and Immigration Services or refugee travel document.
A United States certificate of naturalization or a United States certificate of citizenship.
A tribal certificate of Indian blood or a tribal or bureau of Indian affairs affidavit of birth.
Any other license issued by the Federal Government, any other State Government, an Agency of this State or a Political Subdivision of this State that
requires proof of citizenship or lawful alien status before isuing the license.
Other acceptable document as determined by the Department.
LICENSING TIMEFRAMES
The license application review process occurs within timeframes established under the authority of A.R.S. § 41-1073, and detailed in A.A.C. R19-2-106 and R19-2-306.
Administrative completeness review timeframe—85 days
If the license application is incomplete, the Division of Racing will issue a written notice that specifies what information is required and return the license application.
A license application is considered withdrawn if the applicant or licensee fails to file a complete license application within 15 days of being notified that the license
application is incomplete.
Substantive review timeframe—5 days after determining that a license application is administratively complete, the Division of Racing determines whether the new applicant or
returning licensee meets all substantive requirements. If the requirements are met, the license is issued. If not, the license is denied.
Overall time frame—90days.
CONTACT INFORMATION
RACING SEASON: October thru May: TURF PARADISE - DIVISION OF RACING-LICENSING OFFICE - 1501 W. Bell Road, Phoenix, AZ 85023 602-866-1890
**To ensure faster processing during Race Meets, mail applications DIRECTLY to the track**
Licensing questions: JUNE THROUGH SEPTEMBER contact Racing Division: 602-364-1709
ARIZONA DEPT OF GAMING – RACING DIVISION LICENSING – 1110 W Washington, Suite 450, Phoenix, AZ 85007
ADR230 REVISED 11/2017
ARIZONA DEPARTMENT OF GAMING - RACING DIVISION
LICENSE APPLICATION INSTRUCTIONS
• Submit a complete application. Signature required on page 4. BE SURE TO INCLUDE COPY OF GOVERNMENT PICTURE I.D.
• Submit two (2) fingerprint cards* and a check for $22.00 (fingerprint processing fee). Persons under 18 years of age do not require prints.
*FINGERPRINTS MUST BE ON FD-258 CARDS ONLY. NO CANADIAN FINGERPRINT CARDS WILL BE ACCEPTED.
• The Division of Racing does NOT participate in reciprocity with other racing jurisdictions.
• National Racing Compact members do not need to submit fingerprints.
• Submit CASH, CASHIER’S CHECK or MONEY ORDER in U.S. dollars only payable to: ARIZONA DEPARTMENT OF GAMING, to cover the licensing fee(s) and
fingerprint processing.
NO PERSONAL CHECKS ACCEPTED.
ARIZONA STATEMENT OF CITIZENSHIP and ALIEN STATUS
BY APPLICANTS FOR STATE PUBLIC BENEFITS – Professional and Commercial License
Qualified Alien status
An alien lawfully admitted for permanent residence under the Immigration and Nationality Act (INA).
An alien who is granted asylum under § 208 of the INA.
A refugee admitted to the United States under § 207 of the INA.
An alien paroled into the United States for at least one year under § 212(d)(5) of the INA.
An alien whose deportation is being withheld under § 243(h) of the INA.
An alien granted conditional entry under § 203(a)(7) of the INA as in effect prior to April 1, 1980.
An alien who is a Cuban or Haitian entrant (as defined in § 501(e) of the Refugee Education Assistance Act of 1980.)
An alien who is, or whose child or child’s parent is a “battered alien” or an alien subjected to extreme cruelty in the United States.
Nonimmigrant status
A non immigrant under the Immigration & Nationality Act (8 USC § 1101 et seq). Non immigrants are persons who have temporary status for a specific purpose. (See 8
USC § 1101(a)(15).
Alien Paroled into the United States for less than One Year under § 212(d)(5) of the INA.
Other Persons
A nonimmigrant whose visa for entry is related to employment in the United States.
A citizen of a freely associated state, if § 141 of the applicable compact of free association approved in Public Law 99-239 or 99-658 (or a successor provision) is in effect.
(Freely Associated States include Republic of the Marshall Islands, Republic of Palau and the Federate States of Micronesia, 48 USC § 1901 et seq)
A foreign national not physically present in the United States
Otherwise Lawfully Present
A person not described in any of the above categories who is otherwise lawfully present in the United States.
• Submit one (1) of the following documents in support of your declaration. PROVIDE A GOVERNMENT PICTURE ID.
• EXCEPTIONS: Applicants who have applied through the National Racing Compact; Applicants for a temporary license who will provide documentation per A.R.S.5-
107.01(f) or Applicants who are citizens of a foreign country & not physically in the U.S.
An Arizona driver license issued after 1996 or an Arizona nonoperating identification license.
A driver license issued by a state that verifies lawful presence in the United States. (The following states do not verify, and therefore are not acceptable:
Illinois, Maryland, New Mexico, Utah and Washington. Washington verifies only for credentials labeled as “Enhanced.”)
Enhanced Driver License or ID Card issued by another state, territory or possession of the U.S.
E-Verification issued by the Department of Homeland Security verifying employment eligibility.
A Permanent Resident Card (green card)
A birth certificate or delayed birth certificate issued in any state, territory or possession of the U.S.
A United States certificate of birth abroad.
A United States passport or a foreign passport with a United States visa.
An I-94 form with a photograph.
Employment Authorization Card issued by the United States Citizenship and Immigration Services or refugee travel document.
A United States certificate of naturalization or a United States certificate of citizenship.
A tribal certificate of Indian blood or a tribal or bureau of Indian affairs affidavit of birth.
Any other license issued by the Federal Government, any other State Government, an Agency of this State or a Political Subdivision of this State that
requires proof of citizenship or lawful alien status before isuing the license.
Other acceptable document as determined by the Department.
LICENSING TIMEFRAMES
The license application review process occurs within timeframes established under the authority of A.R.S. § 41-1073, and detailed in A.A.C. R19-2-106 and R19-2-306.
Administrative completeness review timeframe—85 days
If the license application is incomplete, the Division of Racing will issue a written notice that specifies what information is required and return the license application.
A license application is considered withdrawn if the applicant or licensee fails to file a complete license application within 15 days of being notified that the license
application is incomplete.
Substantive review timeframe—5 days after determining that a license application is administratively complete, the Division of Racing determines whether the new applicant or
returning licensee meets all substantive requirements. If the requirements are met, the license is issued. If not, the license is denied.
Overall time frame—90days.
CONTACT INFORMATION
RACING SEASON: October thru May: TURF PARADISE - DIVISION OF RACING-LICENSING OFFICE - 1501 W. Bell Road, Phoenix, AZ 85023 602-866-1890
**To ensure faster processing during Race Meets, mail applications DIRECTLY to the track**
Licensing questions: JUNE THROUGH SEPTEMBER contact Racing Division: 602-364-1709
ARIZONA DEPT OF GAMING – RACING DIVISION LICENSING – 1110 W Washington, Suite 450, Phoenix, AZ 85007
ADR230 REVISED 11/2017
LICENSING FEES
RACING DIVISION
ARIZONA DEPARTMENT OF GAMING
All fees are payble by Cash, Credit Card, Cashier's Check or Money Orders in U.S. Dollars
Payable to Arizona Department of Gaming
NO PERSONNEL CHECKS WILL BE ACCEPTED
TRACK PARTICIPANTS
FINGERPRINT FEE
TOTAL FEES
Assistant Starter / Valet
$15
$22
$37
Authorized Agent – Full
$200
$22
$222
Authorized Agent – Partial
$50
$50
$37
Exercise Rider
$15
$22
Groom
$15
$22
$37
Jockey & Apprentice
$200
$22
$222
$72
Jockey Agent
$50
$22
Mutuel (including OTB)
$15
$22
$37
Occupational
$15
$22
$37
Official
$100
$22
$122
OTB (owners, managers)
$15
$22
$37
Outrider
$15
$22
$37
Plater/Farrier
$200
$22
$222
$37
Pony Person
$15
$22
Security Employee
$15
$22
$37
Veterinarian
$200
$22
$222
OWNERS/TRAINERS
Owner, Temp to Claim Owner
$150
$22
$172
Trainer, Assistant Trainer
$150
$22
$172
Owner/Trainer
$200
$22
$222
STABLE OPERATION
Stable Name
$150
$150
VENDORS
All Other Vendors
$500
$500
Vendor Employees
$50
$22
$72
TOTE COMPANY / EMPLOYEES - ANNUAL FEES
Tote Company
$1,250
$1,250
$72
Tote Employees
$50
$22
ADR 200 Revised 12/2016
ARIZONA DEPARTMENT OF GAMING - RACING DIVISION 1110 W. Washington, Suite 450 Phoenix, AZ 85007 Telephone (602) 364-1700 www.racing.az.gov
FOR RACING DIVISION USE ONLY
Applicant ID#__________________ Issue Date: __________________
Expiration Date: _______________
RACING DIVISION LICENSE APPLICATION / TERMS AND CONDITIONS
APPLICATION DATE: _____________________________________
TRACK/OTB: _______________________________________________
LICENSE CATEGORY: _____________________________________
EMPLOYER NAME: _______________________________________
EMPLOYER SIGNATURE: ________________________________________
Please Print
APPLICANT’S NAME
Last
First
Middle
(Jr, Sr., etc.)
Other Names You Have Used (maiden/other)
Social Security No. __________________________
Date of Birth ____________________
Place of Birth _____________________________
Are you a Citizen or Naturalized Citizen of the United States?
Yes
No
If No what country? ______________________________
Alien Registration Number/Expiration Date ____________________________________
UNDER 18 YEARS OF AGE (if applicable)
• Applicants under the age of 18 require signature of parent / legal guardian
• Applicants for Owner under the age of 16 also require the parent / legal guardian
By signing, I give my permission for licensure of this minor and assume full responsibility, including financial responsibility, for such licensure.
Signature of parent / legal guardian: __________________________________ _____________________ Relation: __________________________
Permanent Mailing Address: Please be advised that the address listed below will be used for mailing all notices or other communication. It is the
sole responsibility of the licensee to notify the Department of a change in mailing address.
Mailing Address
Apt/Suite
City
State/Zip
Home Ph.
_ _________________
Cell Ph.
___________________
E-Mail__________________
Sex
Eye
Hair_______________
Height
Weight
_
Has your racing license ever been denied, suspended, or revoked?
Yes
No
CRIMINAL HISTORY BACKGROUND - All license applicants are required to provide answers to the criminal history background questions. An applicant
who intentionally or recklessly provides false information concerning his/her criminal history background is subject to license suspension or
revocation. A.R.S. § 5-108(E) A summary of offenses that may cause a license to be denied, suspended or revoked is available. Any Outstanding
Warrants found during the background investigation may result in immediate suspension of your license.
The questions below refer to all arrests, detentions, charges, indictments, citations or summons to answer for any criminal offense
or violation for any reason whatsoever (except minor traffic violations), regardless of the disposition of the event, dismissals,
expunged/sealed or restoration of civil rights.
Have you EVER been charged with a criminal offense or arrested? …………………….…………………..…………………………..
Yes
No
1.
2. Have you been convicted of a misdemeanor in the past five (5) years? ……………..…………………………………………………
Yes
No
3. Have you EVER BEEN CONVICTED of a felony? ……………………………………………………………………………………………………..
Yes
No
4. Are you currently on parole or probation?.…………………………………………………………………………………………………………….
Yes
No
IF YOU ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS – PLEASE PROVIDE AN EXPLANATION ON PAGE 3
ADR 201 License Application / Terms & Conditions (Revised 6/2016
ARIZONA DEPARTMENT OF GAMING - RACING DIVISION 1110 W. Washington, Suite 450 Phoenix, AZ 85007 Telephone (602) 364-1700
OWNERS – PLEASE PROVIDE THE FOLLOWING INFORMATION
1.
How does your name appear on animal registration papers?
2.
Who is your Arizona licensed trainer?
3.
Do you race under a stable name in Arizona?
Yes Stable Name__________________________________________
No
4.
List the names of the horses you plan to race in Arizona.
Name(s) of Other Owner(s)
or Anyone With an Interest
Name of Animal(s)
% Owned
in the Named Animal
%Owned
Other Owner(s) City, State, & Country
TRAINERS – LIST OWNERS FOR WHOM YOU ARE NOW TRAINING
Name of Owner (Last, First, Middle Initial)
Address (City, State, Zip Code, Country)
JOCKEY AGENTS - LIST JOCKEYS YOU ARE REPRESENTING
Name of JOCKEY (S)
1.
2.
3.
FOR RACING DIVISION USE ONLY
CITIZENSHIP DOCUMENTATION SUBMITTED:
Yes
No
VISA:
Yes
No
MAIL IN APPLICATION
Fees :
License Fee: ______________ + Fingerprint Fee:
____________ = Total Fees Due: _____________________
Payment Type:
Cash
Cashier’s Check #_____________________
M.O # ____________________________
Credit Card Authorization # ___________________
Receipt # _________________________
RCI:
No Rulings
Rulings Reviewed AZ Racing Infractions:
Yes
No
LICENSING TECHNICIAN
INVESTIGATOR
BOARD OF STEWARDS
Reviewed (initial/date) ______________________
Approved
Denied
Interviewed (initial/date)
Processed (Initial) _____________
(initial/date)
Applicant states all arrests and convictions have been listed
ADR 201 License Application / Terms & Conditions (Revised 6/2016
2
ARIZONA DEPARTMENT OF GAMING - RACING DIVISION 1110 W. Washington, Suite 450 Phoenix, AZ 85007 Telephone (602) 364-1700
Arrest Disclosure Form - Attach additional sheets as necessary
Charges (s):
Date arrested/charged:
Agency that arrested/charged you:
Court where you appeared:
Disposition & Date (Jail, Fine, Probation):
Charges (s):
Date arrested/charged:
Agency that arrested/charged you:
Court where you appeared:
Disposition & Date (Jail, Fine, Probation):
Charges (s):
Date arrested/charged:
Agency that arrested/charged you:
Court where you appeared:
Disposition & Date (Jail, Fine, Probation):
Charges (s):
Date arrested/charged:
Agency that arrested/charged you:
Court where you appeared:
Disposition & Date (Jail, Fine, Probation):
ADR 201 License Application / Terms & Conditions (Revised 6/2016
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