MAIN LIC#_________
BUSINESS LICENSE APPLICATION
(Please type or print)
BUSINESS NAME:
BUSINESS ADDRESS:
BUS. PHONE#
FAX E-MAIL
______
BILLING ADDRESS:
(If different)
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN):
ILLINOIS BUSINESS TAX NUMBER (IBT) (REQUIRED)
PROPERTY TAX NUMBER (PIN):
BUSINESS OWNERSHIP TYPE: (if corporate, list officers including registered agent)
_________ Corporation ________ Partnership ________ Individual Proprietor
Name: Title: Home Address: Phone:
Drivers License #
PROPERTY OWNER:
ADDRESS:
NATURE OF BUSINESS: (describe the operation in brief including product type) also SIC – CODE_______________
TOTAL NUMBER OF EMPLOYEES:
Maximum on one shift:
TOTAL SQUARE FOOTAGE OF: Building (s)
Your Unit
COIN OPERATED MACHINES ON PREMISES: (number and type ) candy ______ coffee ______soda/pop __________
ice cream
cigarette sandwiches (refrigerated) _____________________________________
general snacks (non-refrigerated)
games other none ________
RESTAURANTS: (Health permit & special use required)
Have you applied for your special use to operate a restaurant? Yes: No
Seating capacity total _______ Outdoor Seating ____ Carry-out Yes: No
Restaurants, Food Stores, Food Processors:
Have you applied for all required health permits? Yes: No
(complete backside)
INDUSTRIAL MANUFACTURING PROCESSING F FACILITIES describe type of product
Manufactured / warehoused / processed (check all that apply):
HAVE YOU submitted copies of your material safety data sheets to the Fire Department? Yes: No
HAVE YOU contacted the C
ook County Department of Environmental Control to apply for any necessary permits?
Yes: No
HAVE
YOU applied to the Metropolitan Water Reclamation District of Greater Chicago for any required permits?
Yes: No
HAS THE APPLICANT, business owner, or any off icer or partner associated with this business ever been convicted of a
felony or other offense involving moral turpitude? Yes: No: If yes, please explain:
On this ______ day of _________________, 20___, before me appeared
____________________________________________(applicant’s printed name) who duly sworn deposes and says that
they have read the foregoing application by them subscribed; and that they understand the contents thereof; that the
information given by them is true and that they had been informed and understand that any false information given by
them shall be cause for revocation of any licenses issued herein. He or she further states that they have viewed all
appropriate village ordinances relating to the operation of a business and that unless all ordinances are complied with, no
license will be issued.
Applicant’s signature Title Date of Application
Notary Public County, IL
my commission expires
** PLEASE NOTE – application must be notarized before returning to village.
** PLEASE NOTE*** Any changes made in ownership of Business or any Business name changes,
Business address changes will require the completion of a new Business License Application.
FOR Licenses required for fiscal year ___________ ISSUED BY ______________
OFFICE
USE CLASS TYPE _________ FEE _______ COMMERCIAL ALARM FEE _____________
FINGERPRINT/BACKGROUND CHECK FEE
Community Development ___APP ___REJ DATE_________
Police Department Manager ___APP ___REJ DATE_________
Fire Department ___APP ___REJ DATE_________
Water Billing ___APP ___REJ DATE_________