VILLAGE OF NOBLE

 

BUSINESS LICENSE APPLICATION

 

APPLICATION NO. __________ ANNUAL LICENSE FEE DUE MAY 1ST: $                        

 

(PLEASE TYPE OR PRINT)

 

1.       Applicant’s Name:_______________________________________ PHONE (    )            

2.       Applicant’s Address                                                                                         

          City_________________________________         State_______________        ZIP    

3.       Length of resident at above address  ________years ____________months

4.       Applicant’s Date of Birth ___/___/___                  Social Security No.                       

5.       Marital Status ___________________         Name of Spouse                                   

6.       Citizenship of Applicant                                                                                    

7.       Business Name____________________________________________      PHONE (    )  

8.       Business Address                                                                                            

          City_________________________________         State_______________        ZIP    

9.       Length of Employment _________years _____________months

10.     All residences and addresses for the last three (3) years if different than above:

          ________________________________________________________________________

          ________________________________________________________________________

11.     Name and Address of employers during the last three (3) years if different than above:

          ________________________________________________________________________

          ________________________________________________________________________

12.     List the last three (3) municipalities where applicant has carried on business immediately preceding the date of application:

          ________________________________________________________________________

13.     A description of the subject matter that will be used in the applicant’s business:

          ________________________________________________________________________

14.     Has the applicant ever had a license in this municipality?  [  ]  Yes   [  ]  No

          If so, when ______________________________________________________________

15.     Has a license issued to this applicant ever been revoked?     [  ]  Yes   [  ]  No

          If “yes”, explain: _________________________________________________________

16.     Has the applicant ever been convicted of a violation of any of the provisions of this Code, etc.?

          [  ]  Yes   [  ]  No      If “yes”, explain:                                                                

          ________________________________________________________________________

17.     Has the applicant ever been convicted of the commission of a felony? [  ] Yes [  ]  No

          If “yes”, explain:                                                                                             

18.     LICENSE DATA:        Term of License                                                                

                                      Fee for License $                                                               

                                      Sales Tax Number                                                              

                                      License Classification                                                

19.     LIST ALL OWNERS IF LICENSE IS FOR LOCAL BUSINESS (PERMANENT):

                                                                                                                             

                                                                                                                             


OFFICIAL BUSINESS LICENSE

 

 

STATE OF ILLINOIS                          )

COUNTY OF RICHLAND                    )  ss.

VILLAGE OF NOBLE                           )

 

                                      ILLINOIS SALES TAX NUMBER                                     

 

 

TO ALL TO WHOM THESE PRESENTS SHALL BECOME GREETINGS:

 

          WHEREAS                                                                                                  , having complied with all the requirements of the laws of the State of Illinois and the ordinances of the Village of Noble, Illinois in this behalf made and required license is, by authority of the Village of Noble, Illinois given and granted to the                                                      to                                             at                                                                                             in the Village of Noble, County of Richland, and State of Illinois, from the                     date hereof until the                  day of                                      , __, said                                                                          to be subject to all laws of the State of Illinois and all ordinances of the Village of Noble, Illinois, not in conflict therewith, which are now or hereafter may be in force touching the premises.

 

 

(L.S.)

 

          Given under the hand of the Mayor of the Village of Noble, County of Richland, Illinois and the seal thereof, this              day of                   , ____.

 

 

                                                                                                                            

                                                          MAYOR

                                                          VILLAGE OF NOBLE

 

COUNTERSIGNED:

 

 

                                               

VILLAGE CLERK

VILLAGE OF NOBLE

 

(SEAL)


APPLICATION FOR RAFFLE LICENSE

 

Organization Name:                                                                                                  

Address:                                                                                                                 

Type of Organization:                                                                                                

Length of Existence of Organization:                                                                             

 

If organization is incorporated, what is the date and state of incorporation?

Date:                                                   State:                                                           

 

List the organization’s presiding officer, secretary, raffle manager, and any other members responsible for the conduct and operation of the raffle.

 

PRESIDENT:

 

SECRETARY:                                                             Birth Date:                                 

Address:                                                                                                                 

Social Security No.:                                                    Phone No.:                                 

 

RAFFLE MANAGER:                                                    Birth Date:                                 

Address:                                                                                                                 

Social Security No.:                                                    Phone No.:                                 

 

List any other members responsible for the conduct and operation of the raffle on the back of this page.  List name, date of birth, address, social security number, and phone number.

 

                             This request is for a single raffle license.

                             This request is for a multiple raffle license.

 

The aggregate retail value of all prizes to be awarded: $                                                   

Maximum retail value of each prize to be awarded in the raffle: $                                       

The maximum price charged for each raffle chance issued:                                                

The area or areas in which raffle chances will be sold or issued:                                                                                                                                                                      

Time period during which raffle chances will be issued or sold:                                                                                                                                                                        

The date, time and location at which winning chances will be determined:                                                                                                                                                         

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

If multiple raffles license is requested, list on a separate sheet, the date, time, and location for each raffle to be held within the one (1) year period of time from the date of the issuance of the license.

 

THE APPLICATION FEES ARE NONREFUNDABLE EVEN SHOULD THE APPLICATION BE REJECTED BY THE VILLAGE BOARD.


APPLICATION FOR RAFFLE LICENSE

 

 

SWORN STATEMENT

 

 

          The following officers attest to the not-for-profit character of the applicant organization.

 

 

                                                                                                                            

(NAME OF ORGANIZATION)

 

 

          Dated this                          day of                                       ,         .

 

 

                                                                                                                            

                                                                   PRESIDING OFFICER

 

 

                                                                                                                            

                                                                   SECRETARY

 

 

 

STATE OF ILLINOIS                      )

                                                )        ss.

COUNTY OF RICHLAND                 )

 

 

          Signed and sworn to before me this            day of                    ,         .

 

 

                                                                                                                             

PRESIDING OFFICER                                        SECRETARY

 

 

 

                                                                                                                            

                                                                   NOTARY PUBLIC


SINGLE RAFFLE LICENSE

 

License No.:                                                                                                            

 

Organization Name:                                                                                                  

 

Address:                                                                                                                 

 

Area or areas in which raffle chances may be sold or issued:                                              

                                                                                                                            

                                                                                                                            

 

Period of time during which raffle chances may be sold:                                                    

                                                                                                                            

                                                                                                                            

 

Maximum price charged for each raffle chance issued or sold: $                                         

 

Date, time and location at which winning chance will be determined:

 

Date:                                                             Time:                                                 

 

Location:                                                                                                                

 

THIS LICENSE SHALL BE PROMINENTLY DISPLAYED AT THE TIME AND LOCATION OF THE DETERMINATION OF THE WINNING CHANCES.

 

          WITNESS the hand of the Mayor of the Village of Noble and the Corporate Seal thereof, this                        day of                             ,         .

 

 

                                                                                                                            

                                                                   MAYOR

                                                                   VILLAGE OF NOBLE

 

                                                         

VILLAGE CLERK

VILLAGE OF NOBLE

 

(SEAL)


MULTIPLE RAFFLE LICENSE

 

License No.:                                                                                                            

 

Organization Name:                                                                                                  

 

Address:                                                                                                                 

 

Area or areas in which raffle chances may be sold or issued:                                              

                                                                                                                            

                                                                                                                            

 

Period of time during which raffle chances may be sold:                                                    

                                                                                                                            

                                                                                                                            

 

Maximum price charged for each raffle chance issued or sold: $                                         

 

This is a license for multiple raffles to be held within the maximum period of one (1) year from date of this license.  The date, time and location of each raffle is as set forth on Exhibit 1, attached hereto and hereby incorporated by reference.

 

THIS LICENSE SHALL BE PROMINENTLY DISPLAYED AT THE TIME AND LOCATION OF THE DETERMINATION OF THE WINNING CHANCES.

 

          WITNESS the hand of the Mayor of the Village of Noble and the Corporate Seal thereof, this                        day of                             ,         .

 

 

                                                                                                                            

                                                                   MAYOR

                                                                   VILLAGE OF NOBLE

 

                                                         

VILLAGE CLERK

VILLAGE OF NOBLE

 

(SEAL)


EXHIBIT 1

 

 

            The following is the date, time and location at which winning chances will be determined for multiple raffles to be held within a maximum period of one (1) year from the date of issuance of this license.

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                

 

Date:                                                             Time:                                                 

Location:                                                                                                                


APPLICANT/FIELD CHECK

 

INFORMATION CARD

 

 


                                                                                                                            

Name                                                           Location                 Date             Time

                                                                                                                            

Residence Address                                         D.L.#

                                                                                                                            

Business Address                                           Vehicle   Color   Yr.   Body  License   Info

                                                                                                                            

Occupation                                                    Vehicle Modifications:

                                                                                                                            

Social Security Number                                  

                                                                                                                            

Race                       Sex              Height

                                                                   Action Leading to Check:                     

Weight                   Eyes             Hair                      

                                                                                                                            

Complexion                      Date of Birth

                                                                                                                           

Unusual Features:

                                                                                                                            

                                                                   Comments:

                                                                                                                            

 

                                                                                                                            

 

                                                                                                                            

 

                                                                                                                            

 

                                                                                                                            

Hat                        Coat                                Associates:

                                                                                                                            

Cap                       Jacket

                                                                                                                            

Blouse                    Dress

                                                                                                                            

Shirt                      Sweater

                                                                                                                            

Skirt                      Trousers