Fillable VILLAGE OF WHEELING COIN OPERATED/VENDING MACHINE COMMUNITY DEVELOPMENT (Village of Wheeling)

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VILLAGE OF WHEELING COIN OPERATED/VENDING MACHINE COMMUNITY DEVELOPMENT (Village of Wheeling)

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U.S.A. forms for Village of Wheeling

BROWSE VILLAGE OF WHEELING (IL) FORMS

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VILLAGE OF WHEELING
COMMUNITY DEVELOPMENT
2 COMMUNITY BOULEVARD
WHEELING, ILLINOIS
(847) 459-2620
COIN OPERATED/VENDING MACHINE
LICENSE APPLICATION
______________, 20_____ TO APRIL 30, 20_____
BUSINESS NAME:
PHONE NUMBER: _________________________________________________________________________
CONTACT NAME: ______________________________________________________________________
ADDRESS:
LOCATION OF MACHINE(S)
(IF OTHER THAN ABOVE):
(Use separate application for each location)
Please indicate number of machines below by class type and remit total license fee with regular license amount.
Information on machine class types is listed below.
CLASS
TYPE
NUMBER OF
MACHINES ON
PREMISES
FEES FOR
EACH
MACHINE
TOTAL
FEES
(for village use only)
LICENSE ISSUED
F1
F2*
F3
F4
TOTAL FEES INCLUDED
*Affidavit, Coin Operated Amusement Device required. Limit of four (4) game-type machines in one location based on
f
loor size.
A
pplication is hereby made for the license(s) indicated above. I agree to abide by all laws and ordinances pertaining to
the operation of said machines.
Applicant’s Signature Date
L
icense Classes:
F
1: Cigarette, cigar and other tobacco products
F2: Jukeboxes, other amusement devices
F3: Machines dispensing potentially hazardous foods. These include cup-type machines, refrigerated
machines with perishable foods, etc. These do not include can-type soda machines, candy
machines, etc.
F4: Other coin-op machines (including can-type soda, pre-packaged candy, etc.)
$ 104.00
$ 0.00
$ 27.75
$ 0.00
$ 69.25
$ 0.00
$ 14.00
$ 0.00
$ 0.00
RESET FORM
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VILLAGE OF WHEELING COIN OPERATEDVENDING MACHINE COMMUNITY DEVELOPMENT (Village of Wheeling)

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Completed 17 July 2020

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