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City of Bloomington, Illinois

cityclerk@cityblm.org

115 E. Washington St., Bloomington, IL, 61701, US

309-434-2509

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Amusement Device Owner License Application
This license type applies to any person or entity who sets up for operation more than three amusement devices, or who sets up any such device for operation in any location or establishment not owned or operated by them or it, or who leases or distributes any such device for the purpose of operation by another.
Submission:
In order for this application to be considered, Applicants must submit the following:
  1. If the Applicant will use a different name with the public than the name of the legal entity, proof of the DBA/Assumed Name is registered with the State of Illinois or the County of McLean.
  2. List of Establishments and Number of Devices for each. The list should model the following for each location:
    1. Establishment’s Legal Entity Name; DBA (Assumed Name); Establishment Address; # of Devices
    2. Etc.…
Application & License Fees:
Application Fee: $250
Annual License Fee: $250
Annual Fee per Device: $75
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Once the application is submitted, a $250, non-refundable, application fee will be invoiced. Once the invoice is paid, a review of the application and supporting documents will begin. If any documentation is missing or incorrect, the application will be sent back to the Applicant and the review will start back over once all required documents have been submitted. Applications are reviewed on a first-come, first-served basis. Incomplete applications will not be given review preference.
Please check that you agree before continuing.
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored. I agree to electronically sign and to create a legally binding contract between the City of Bloomington and myself, or the entity I am authorized to represent.
Your Name HereClick to Sign
Signature HereClick to Sign
11/15/2024Click to Sign
I.N.Will Update Upon Signing

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Please Upload the Required Attachment(s)

Please upload the following attachments:

  1. If Applicant will use a different name with the public than the name of the legal entity, proof of the DBA/Assumed Name is registered with the State of Illinois or the County of McLean
  2. List of Establishments and Number of Devices for each as detailed on page 2 of the application.
List of Establishments and Number of Devices for each as detailed on page 2 of the application Click Here to Upload
If applicable - Proof of registered DBA/Assumed Name with the State of IL or McLean County Click Here to Upload