TITLE 26: ELECTIONS
CHAPTER I: STATE BOARD OF ELECTIONS
PART 210 RAFFLES CONDUCTED BY POLITICAL COMMITTEES
SECTION 210.APPENDIX A APPLICATION FORM


 

Section 210.APPENDIX A  Application Form

 

FORM DR

LICENSE APPLICATION TO

CONDUCT A RAFFLE

1.

Name and address of political committee.

 

 

2.

Type of Committee  (Circle One)

 

 

 

 

Candidate

Political Party

Political Action Committee

Ballot Initiative

3.

Name and address of officers.

 

A.

Chairman

 

 

 

 

Phone Number:

 

 

B.

Treasurer

 

 

 

 

Phone Number:

 

4.

Name and address of individuals responsible for the conduct of the raffle.

 

 

 

 

 

5.

Locations where raffle chances will be sold or issued.

 

 

6.

First and last dates for sale of raffle chances.

 

 

 

 

7.

Locations where winning chances will be determined.

 

 

8.

Dates of determination of winning chances.

 

 

 

 

Briefly describe the prizes:

 

 

 

 

 

 

 

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

 

The undersigned hereby swear and affirm that __________________________________ is organized as a political committee in Illinois as required by Article 9 of the Election Code and is eligible to receive a raffle license as prescribed by law, and further, that the above stated facts are true. We acknowledge the receipt of copies of 230 ILCS 15/8.1 and of 26 Ill. Adm. Code 210.10 and understand that failure to abide by the Election Code shall void any license granted to this committee.

 

 

For Office Use Only

Chairman (Signature)

 

Identification No.

 

 

 

Date of Creation:

 

Treasurer (Signature)

 

Subscribed and Sworn to before me this

 

Approved

 

___ day of ____________, 20____.

 

 

(Date)

 

Notary Public

 

(Signature)

 

(Source:  Amended at 35 Ill. Reg. 2407, effective February 4, 2011)