Mazon, IL · Grundy County
Video Gaming License Application
This application is for a business or authorized agent seeking a Village of Mazon video gaming license for a location or truck stop.
What this form is
The application collects information about the applicant, business, licensed premises, and the number of video gaming licenses requested, with one license per terminal. It asks about certain business convictions and, for truck stop establishments, requests verification of facility characteristics and diesel fuel sales. The Village uses the form to review and record approval or denial.
Who needs it
A business applicant or its authorized agent seeking video gaming licenses for a Village of Mazon location needs this application.
How to submit it
The form lists the Village of Mazon at 520 Depot St., PO Box 33, Mazon, IL 60444, and includes a fax number, (815) 448-2098.
About notarization
This document is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Application
Download the Village of Mazon Video Gaming License Application PDF.
- 2
Complete The Form
Enter applicant, business, premises, contact, license, and terminal information, and answer the questions that apply.
- 3
Review Truck Stop Information
If applying as a truck stop establishment, complete the requested facility verification and explain if the stated conditions are not met.
- 4
Sign And Date
The applicant or authorized agent signs and dates the application.
- 5
Submit To The Village
Use the Village of Mazon address or fax number printed on the application.
Frequently asked questions
- Who completes the Video Gaming License Application?
- The business license applicant completes it, or an authorized agent may complete it and provide their relationship to the applicant.
- What information does the application request?
- It asks for applicant and business details, premises and contact information, license numbers, the number of video gaming licenses requested, and answers about certain convictions. Truck stop applicants provide additional facility information.
- Do I need a notary for the Video Gaming License Application?
- No. This document is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
- How do I submit the Video Gaming License Application?
- The form lists the Village of Mazon at 520 Depot St., PO Box 33, Mazon, IL 60444, and provides the fax number (815) 448-2098.