[City of Bloomington, Illinois] Tobacco Renewal Affidavit 2026

Tobacco 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).

Affidavit of License Renewal - By signing the affidavit, the representative verifies that no significant changes have been made to the business operations or premises.
Priority Contacts and Ownership Details Form for Current Licensees. The form can be completed by clicking here.
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.

Conditional Document Requirements

The following are required to be active and on file at all times for all licensees. If the document listed below is currently active and on file, there is no need to include it with your submission.

Lease Agreement (if establishment is not owned). To be accepted, the Lease Agreement must include:
1. Name of Entity or Person(s) under Ownership;
2. Establishment Address (including applicable suite or unit #s); and
3. Term Dates.
$2,000 Surety/Penal Bond. To be accepted, your bond must include all of the following details:
1. Entity Name — The applicant’s name must be listed. If the applicant is a corporation, the corporation’s legal name must appear here.
2. DBA/Assumed Name (if applicable) — If you plan to use a business name that is different from your legal entity name, you must register that name (DBA/Assumed Name) with either the State of Illinois or McLean County.
3. Establishment Address — The address of the location where business is operated.
4. License Type
5. Bond Amount
6. Bond number
7. Term Dates — Start and end dates of the bond.
8. Obligee (who the bond is for) — The following must be listed as the Obligee:
9. 1. City of Bloomington, 115 E. Washington St., Bloomington, IL 61701

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:

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.

All documents can be uploaded by clicking the paperclip on the top-left of the form.

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 that I am authorized to electronically sign on behalf of the business applying for renewal.

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04/15/2026Click to Sign

Signature HereCity Clerk Designee Will Sign Here

04/15/2026

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