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ARE YOU REQUESTING A WAIVER OF FIDELITY BOND PURSUANT
TO SECTION 4.66.150?
YES: NO:
*If yes, complete the following: State reason why the procurement of a
bond in the required amount would constitute an undue hardship. Also,
state what alternative method will be available to protect the public in lieu
of the bond. (attach additional sheet if necessary)
ATTESTATION
“The undersigned attest that the above named organization is
organized not-for-profit under the law of the State of Illinois and has
been continuously in existence for at least 5 years, receding date of
this application, and that during this entire 5 year period preceding
date of application it has maintained a bona fide membership
actively engaged in carrying out its object. The undersigned do
hereby state under penalties of perjury that all statements in the
foregoing application are true and correct; that the officers,
operators and workers of the raffles are bona fide members of the
sponsoring organization and are all of good moral character and
have not been convicted of a felony; that if a license is granted
hereunder, the undersigned will be responsible for the conduct of
the raffle in accordance with the provisions of the laws of the State
of Illinois and this jurisdiction governing the conduct of such
raffles.”
Name of Organization
President/Chairperson
________________________________________________________________________
Village Manager /Approved Date
