CITY OF WOODSTOCK
APPLICATION FOR RAFFLE LICENSE
Type of Raffle: _____ Individual ______ On-Going _____ Regular
(single drawing) (multiple drawings) (one chance / weekly drawings)
Applicant:
Individual as Applicant: Name of Benefit _________________________________________________________________
__________________________________ __________________________________________________ ____/____/_______
First Name Last Name Date of Birth
__________________________________ ______________________ _______________________
Address City Phone Number
Organization as Applicant: Name of Organization: _________________________________________________________
How long has Organization been in existence? _________________
Provide full first name, middle initial, last name, address, and date of birth Organization’s Executive Officer and
Individual Responsible for the Raffle.
Executive Officer / President of Organization
______________ _____ _____________ ______________________ _________________ _________
First Initial Last Address City DOB
Raffle Chair
______________ _____ _____________ ______________________ _________________ _________
First Initial Last Address City DOB
Raffle Information:
Raffle Ticket Price $_______ Number of Chances ___________ Where chances will be sold _____________________
Drawing Date: _______________ Drawing Time: _____________ Drawing Location:_______________________________
Maximum retail value of each prize to be awarded in the raffle. $____________ (use additional sheets if needed)
Total retail value of all prizes $_________ Date Tickets will be Sold: Starting_____________ Ending______________
CERTIFICATE
I, the undersigned, being the person who has signed the within and foregoing Application for raffle license on behalf of the applicant
/ organization, do hereby certify that the applicant / organization is (is not) incorporated under the Not-For-Profit Corporation Act of
the State of Illinois, and is organized for not-for profit purposes: that I have read the within and foregoing application by me
subscribed; that I have personal knowledge of the information contained in the application and that said information is true in
substance and in fact.
Applicant Printed Name ____________________________________ Signature _____________________________________
Subscribed and sworn to before me this _____ day of __________________________ 20 ____.
Notary Public __________________________________________________
This is to certify that the organization named above hereof is hereby authorized and licensed to conduct a raffle on the
dates specified in the within and foregoing application.
DATED at Woodstock, Illinois, this _____ day of __________________________ 20 ____.
Fee:_____ $ 5.00 ____$ 25.00 Local Liquor Commissioner ____________________________________________
