Form RCG-1 Application for Charitable Games License - Illinois

Form RCG-1 is a Illinois Department of Revenue form also known as the "Application For Charitable Games License". The latest edition of the form was released in August 1, 2015 and is available for digital filing.

Download a PDF version of the Form RCG-1 down below or find it on Illinois Department of Revenue Forms website.

ADVERTISEMENT
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
RCG-1
Application for Charitable Games License
Register faster using MyTax Illinois, our online account management program, available on our website at tax.illinois.gov. If you have
questions, visit our website or contact us weekdays between 8:00 a.m. and 4:30 p.m. at 217 785-5864 or email at rev.bptcg@illinois.gov.
Read this information first
To qualify for a license to conduct charitable games, your organization must
• be non-profit and have a federal exemption letter 501(c)(3), 501(c)(4), 501(c)(5), 501(c)(8), 501(c)(10), or 501(c)(19);
• have been organized and in existence in Illinois for at least the past five years or affiliated with and chartered by a national organization
for two years and have had members carrying out the organization’s goals during the applicable period; and
• not have any officers, directors, employees, workers, or operators of charitable games 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.
Step 1: Identify your organization
5
Check the organization type that applies to you:
Corporation
S Corp (Subchapter S Corporation)
1
Federal employer identification number (FEIN)
Not-for-profit organization
FEIN: ______ - __________________
6
Organizations applying for a new charitable games license
must provide the following:
2
Organization name:
• A copy of your organization’s bylaws and one of the following:
__________________________________________________
- Constitution,
- Charter, or
- Articles of incorporation; and
3
Primary or legal business address:
• Copy of meeting minutes from one month of the last five
years, or two years if you are chartered by a national
___________________________________________________
organization.
Street address - No PO Box number
Apartment or suite number
• A copy of your 501(c) letter from the Internal Revenue
___________________________________________________
Service regarding your tax-exempt status.
City
State
ZIP
Note: If renewing your license, you do not have to provide the
above information.
4
Mailing address if different from the address above:
7
Identify a contact person regarding your organization
___________________________________________________
Name: __________________________ Title: _____________
In-care-of name
Phone: (______) ______ - ________ Ext.: __________
___________________________________________________
Street address or PO Box number
Apartment or suite number
FAX:
(______) ______ - ________
___________________________________________________
Email address: _____________________________________
City
State
ZIP
Step 2: Identify your officers and the person in charge
8
Provide 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.
a
_______ - _____ - ________
____________________________
c
_______ - _____ - ________
____________________________
President’s name
Social Security number
Treasurer’s name
Social Security number
________________________________________________________
________________________________________________________
Home address - No PO Box number
City
State
ZIP
Home address - No PO Box number
City
State
ZIP
____ / ____ / ________
(______) ______ - ________
____ / ____ / ________
(______) ______ - ________
Date of birth
Phone
Date of birth
Phone
b
_______ - _____ - ________
____________________________
d
_______ - _____ - ________
____________________________
Secretary’s name
Social Security number
Person-in-charge’s name*
Social Security number
________________________________________________________
________________________________________________________
Home address - No PO Box number
City
State
ZIP
Home address - No PO Box number
City
State
ZIP
____ / ____ / ________
(______) ______ - ________
____ / ____ / ________
(______) ______ - ________
Date of birth
Phone
Date of birth
Phone
* Must be a member of the organization and be present for the entire event.
Step 3: Tell us about the gambling equipment used in your charitable games events
9
Does your organization own any of the gambling equipment you will use in your charitable games event? _____ Yes _____ No
10
If “yes,” you must complete Form RCG-9. If “no,” provide the following information for all persons or organizations from whom you will
purchase, lease, rent, or borrow any gambling equipment used at your charitable games event. Attach additional sheets if necessary.
___________________________________________________
___________________________________________________
Name
Name
___________________________________________________
___________________________________________________
Street address - No PO Box number
City
State
ZIP
Street address - No PO Box number
City
State
ZIP
Supplier’s license number CS-___________________________
Supplier’s license number CS-___________________________
or if borrowed, charitable games license no. CG-_____________
or if borrowed, charitable games license no. CG-_____________
RCG-1 front (R-08/15)
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
RCG-1
Application for Charitable Games License
Register faster using MyTax Illinois, our online account management program, available on our website at tax.illinois.gov. If you have
questions, visit our website or contact us weekdays between 8:00 a.m. and 4:30 p.m. at 217 785-5864 or email at rev.bptcg@illinois.gov.
Read this information first
To qualify for a license to conduct charitable games, your organization must
• be non-profit and have a federal exemption letter 501(c)(3), 501(c)(4), 501(c)(5), 501(c)(8), 501(c)(10), or 501(c)(19);
• have been organized and in existence in Illinois for at least the past five years or affiliated with and chartered by a national organization
for two years and have had members carrying out the organization’s goals during the applicable period; and
• not have any officers, directors, employees, workers, or operators of charitable games 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.
Step 1: Identify your organization
5
Check the organization type that applies to you:
Corporation
S Corp (Subchapter S Corporation)
1
Federal employer identification number (FEIN)
Not-for-profit organization
FEIN: ______ - __________________
6
Organizations applying for a new charitable games license
must provide the following:
2
Organization name:
• A copy of your organization’s bylaws and one of the following:
__________________________________________________
- Constitution,
- Charter, or
- Articles of incorporation; and
3
Primary or legal business address:
• Copy of meeting minutes from one month of the last five
years, or two years if you are chartered by a national
___________________________________________________
organization.
Street address - No PO Box number
Apartment or suite number
• A copy of your 501(c) letter from the Internal Revenue
___________________________________________________
Service regarding your tax-exempt status.
City
State
ZIP
Note: If renewing your license, you do not have to provide the
above information.
4
Mailing address if different from the address above:
7
Identify a contact person regarding your organization
___________________________________________________
Name: __________________________ Title: _____________
In-care-of name
Phone: (______) ______ - ________ Ext.: __________
___________________________________________________
Street address or PO Box number
Apartment or suite number
FAX:
(______) ______ - ________
___________________________________________________
Email address: _____________________________________
City
State
ZIP
Step 2: Identify your officers and the person in charge
8
Provide 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.
a
_______ - _____ - ________
____________________________
c
_______ - _____ - ________
____________________________
President’s name
Social Security number
Treasurer’s name
Social Security number
________________________________________________________
________________________________________________________
Home address - No PO Box number
City
State
ZIP
Home address - No PO Box number
City
State
ZIP
____ / ____ / ________
(______) ______ - ________
____ / ____ / ________
(______) ______ - ________
Date of birth
Phone
Date of birth
Phone
b
_______ - _____ - ________
____________________________
d
_______ - _____ - ________
____________________________
Secretary’s name
Social Security number
Person-in-charge’s name*
Social Security number
________________________________________________________
________________________________________________________
Home address - No PO Box number
City
State
ZIP
Home address - No PO Box number
City
State
ZIP
____ / ____ / ________
(______) ______ - ________
____ / ____ / ________
(______) ______ - ________
Date of birth
Phone
Date of birth
Phone
* Must be a member of the organization and be present for the entire event.
Step 3: Tell us about the gambling equipment used in your charitable games events
9
Does your organization own any of the gambling equipment you will use in your charitable games event? _____ Yes _____ No
10
If “yes,” you must complete Form RCG-9. If “no,” provide the following information for all persons or organizations from whom you will
purchase, lease, rent, or borrow any gambling equipment used at your charitable games event. Attach additional sheets if necessary.
___________________________________________________
___________________________________________________
Name
Name
___________________________________________________
___________________________________________________
Street address - No PO Box number
City
State
ZIP
Street address - No PO Box number
City
State
ZIP
Supplier’s license number CS-___________________________
Supplier’s license number CS-___________________________
or if borrowed, charitable games license no. CG-_____________
or if borrowed, charitable games license no. CG-_____________
RCG-1 front (R-08/15)
Step 4: Tell us about your charitable games events
Provide the date, time, location, and provider’s license number of each charitable games event. 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. Note: You must complete and retain in
your records Forms RCG-2 and RCG-10 for each of the events listed below.
First licensed year: First event
Third event
a.m.
a.m.
a.m.
a.m.
_____/_____/_____
_____ : _____
to _____ : _____
_____/_____/_____
_____ : _____
to _____ : _____
00
00
00
00
p.m.
p.m.
p.m.
p.m.
Month
Day
Year
Hour
Minute
Hour
Minute
Month
Day
Year
Hour
Minute
Hour
Minute
_____________________________________________________
_____________________________________________________
Street address - No PO Box number
Apartment or suite number
Street address - No PO Box number
Apartment or suite number
_____________________________________________________
_____________________________________________________
City
County
State
ZIP
City
County
State
ZIP
Do you own or occupy this premises? ____Yes
_____No
Do you own or occupy this premises? ____Yes
_____No
If no, enter the provider of premises license. CP-______________
If no, enter the provider of premises license. CP-______________
Second event
Fourth event
a.m.
a.m.
a.m.
a.m.
_____/_____/_____
_____ : _____
00
to _____ : _____
00
_____/_____/_____
_____ : _____
00
to _____ : _____
00
p.m.
p.m.
p.m.
p.m.
Month
Day
Year
Hour
Minute
Hour
Minute
Month
Day
Year
Hour
Minute
Hour
Minute
_____________________________________________________
_____________________________________________________
Street address - No PO Box number
Street address - No PO Box number
Apartment or suite number
Apartment or suite number
_____________________________________________________
_____________________________________________________
City
County
State
ZIP
City
County
State
ZIP
Do you own or occupy this premises ____Yes
_____No
Do you own or occupy this premisess ____Yes
_____No
If no, enter the provider of premises license. CP-_______________
If no, enter the provider of premises license. CP-______________
Second licensed year: First event
Third event
a.m.
a.m.
a.m.
a.m.
_____/_____/_____
_____ : _____
to _____ : _____
_____/_____/_____
_____ : _____
to _____ : _____
00
00
00
00
p.m.
p.m.
p.m.
p.m.
Month
Day
Year
Hour
Minute
Hour
Minute
Month
Day
Year
Hour
Minute
Hour
Minute
Provider premises license number CP - ______________________
Provider premises license number CP - ____________________
_____________________________________________________
_____________________________________________________
Street address - No PO Box number
Apartment or suite number
Street address - No PO Box number
Apartment or suite number
_____________________________________________________
_____________________________________________________
City
County
State
ZIP
City
County
State
ZIP
Do you own or occupy this premises? ____Yes
_____No
Do you own or occupy this premises ____Yes
_____No
If no, enter the provider of premises license. CP-______________
If no, enter the provider of premises license. CP-______________
Second event
Fourth event
a.m.
a.m.
a.m.
a.m.
_____/_____/_____
_____ : _____
to _____ : _____
_____/_____/_____
_____ : _____
to _____ : _____
00
00
00
00
p.m.
p.m.
p.m.
p.m.
Month
Day
Year
Hour
Minute
Hour
Minute
Month
Day
Year
Hour
Minute
Hour
Minute
_____________________________________________________
_____________________________________________________
Street address - No PO Box number
Apartment or suite number
Street address - No PO Box number
Apartment or suite number
_____________________________________________________
_____________________________________________________
City
County
State
ZIP
City
County
State
ZIP
Do you own or lease this premises? ____Yes
_____No
Do you own or lease this premises? ____Yes
_____No
If no, enter the provider of premises license. CP-______________
If no, enter the provider of premises license. CP-_______________
Step 5: Pay your fee -
(Note: The fee paid with your application is not refundable.)
Two year charitable games license fee is $400. Make your check or money order payable to the “Illinois Department of Revenue.”
Step 6: 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.
__________________________________________________________________________________________________________________
Signature
Printed name
Date
Mail your completed form, with any
OFFICE OF BINGO AND CHARITABLE GAMES 3-215
required attachments and payment to:
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19480
SPRINGFIELD IL 62794-9480
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.
RCG-1 back (R-08/15)
Reset
Print

Download Form RCG-1 Application for Charitable Games License - Illinois

1335 times
Rate
4.8(4.8 / 5) 67 votes
ADVERTISEMENT
Page of 2