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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 Renewal Affidavit

Below is a list of the document(s) that are required at the time of submission. 

Required Documentation
  • Affidavit of License Renewal - By signing the affidavit, the representative verifies that no significant changes have been made to the business operations or premises.
Conditional Document Requirements
If the following documentation is already on file, it is not required to be submitted with the renewal.
  • List of Establishments and Number of Devices for each. The list should model the following for each location:
    • Establishment’s Legal Entity Name; DBA (Assumed Name); Establishment Address; # of Devices
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.
  • DBA/Assumed Name must be registered. If the Applicant will use a different name with the public than the name of the legal entity, the DBA/Assumed Name must be registered with the State of IL or McLean County.
  • Entities must be in good standing with the State of IL.
All documents can be uploaded after the signature of the affidavit.
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.
11/15/2024Click to Sign
Signature HereClick to Sign
Signature HereCity Clerk Designee Will Sign Here
11/15/2024

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