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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 Device Update Application
This application is intended for Amusement Device Owners who hold an existing license with the City of Bloomington and wish to update the number of devices currently listed on their license.

A device update application must only be submitted for the following reasons:
  1. The number of devices has increased from the number listed on your license
  2. The number of devices has not changed as a whole, but the number at a specific location has shifted (for example: moving devices from one location to another)
NOTE: If the total number of devices has decreased, the application must be submitted by October 1st of each year to ensure the device number is adjusted for your upcoming license renewal. If the application is not received by the deadline, the account will be billed for the existing number of devices.

Application Process:
  1. Once an application is submitted, staff will review and reach out to the applicant by email if any additional information is needed.
  2. Following the review, a City Clerk Department staff member will reach out to discuss the next steps.
Required Documents:
  • A document which lists the following:
    • Establishments where devices are located and the number at each. It should include:
      • Establishment's Legal Entity Name
      • Establishment's DBA (Assumed Name) (if applicable)
      • Establishment Address
As a reminder, device details are not required. Please only submit the information requested above.

Associated Fees:
  • $75 per Additional Device Added
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
Signature HereCity Clerk Designee Will Sign Here
11/15/2024
Signature HereLeslie Yocum Will Sign Here
11/15/2024

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

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Upload Attachment(s)

Please upload the following attachments:

There is a 250MB limit on each attachment.

List of Establishments and Number of Devices Click Here to Upload