Section 3000.755  Information Required for Placement on the Self-Exclusion List

a)         The Administrator shall determine the information and forms to be required of a person seeking placement on the Self-Exclusion List. Such information shall include, but not be limited to, the following:

1)         Full name, including maiden name and alias information;

2)         Home Street Address and/or P.O. Box;

3)         Date of Birth;

4)         Social Security Number;

5)         A copy of his or her driver's license;

6)         A physical description; and

7)         A current photograph.

b)         Failure to provide any information or to execute any forms deemed necessary by the Administrator may result in a denial of a request for placement on the Self-Exclusion List.

c)         Such forms may include a request to waive the liability of the Board, its agents and the State of Illinois for any damages that may arise out of any act or omission related to placement on the Self-Exclusion List.

(Source:  Added at 26 Ill. Reg. 9307, effective June 14, 2002)