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Amusement Device Owner License Renewal Affidavit
Note that this affidavit is applicable to current licensees whose information and statements contained in their last approved application have not changed. If an unapproved change has occurred, please notify the City Clerk Department at cityclerk@cityblm.org immediately.

Below is a list of the document(s) that are required in order for your renewal to be considered complete.

Required Documentation
The following are required to be submitted by all licensees looking to renew their current license(s).
  1. Affidavit of License Renewal - By signing the affidavit, the representative verifies that no significant changes have been made to the business operations or premises.
  2. Priority Contacts and Ownership Details Form for Current Licensees. The form can be completed by clicking here.
  3. A clear photocopy of a Government Issued photo ID for each owner over 20% and Managers of the business. To be accepted, your ID copies must be completely shown in the picture and not be blurry.
  4. A document detailing the Establishments where devices will be located. To be accepted, the document must include only the following:
    1. Legal Entity Name of the business;
    2. DBA/Assumed Name of the business, if applicable;
    3. Complete address of the business, including suite, unit, etc. numbers; and
    4. Total number of devices that will be at that specific location.
As a reminder, device details are not required. Please only submit the information requested above.

Additional Requirements
The following are required in order for renewal to be considered, but documentation is checked internally so there is no submission requirement unless specifically requested.

Doing Business As (DBA)/Assumed Name Registration
DBA/Assumed Names are required to be Registered if the Public-Facing Name is not an exact match to the Legal Entity Name (Example: If ABC Biz, LLC uses the name ABC Pizza with the public, then ABC Pizza must be registered. If ABC Pizza, LLC uses the name ABC Pizza, no need to be registered.)
To register your DBA/Assumed Name. You can find registration information at:
  1. State of Illinois – Assumed Name Registration (Corporations and LLCs); or
  2. McLean County – Doing Business As (DBA)/Assumed Name Registration
All Licensed Entities must be in Good Standing with the State of IL
All entities holding a license must remain in good standing with the State of Illinois. Note that this requirement does not apply to those who are not classified as entities with the State of Illinois.

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Signature HereClick to Sign
Your Name HereClick to Sign
04/15/2026Click to Sign
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Signature HereCity Clerk Designee Will Sign Here
04/15/2026
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Additional Signatures Required

Upload Attachment(s)

Please upload the following attachments:

There is a 250MB limit on each attachment.

List of Devices and Establishments Click Here to Upload
Copy of IDs - Anyone over 20 Percent Ownership and All Managers - Must be Labeled Click Here to Upload