How do I submit the amusement license application?

Submit the application, required Gaming Board license copies, and applicable fees to the Clerk’s Office at 211 Sinclair Avenue, South Roxana, IL 62087.

What documents must accompany the application?

Include copies of valid Illinois Gaming Board licenses for both the licensed establishment and the terminal operator, along with applicable fees for each amusement device.

When are applications and fees due?

Applications and fees are due annually on or before May 1. The form states that all applicable fees must be paid in full before licenses are issued.

South Roxana, IL · Madison County

No notary required

Amusement License Application

South Roxana businesses use this application to request an annual amusement license for video gaming terminals and other coin-operated amusement devices at an establishment.

What this form is

The Village of South Roxana requires this annual application for establishments operating amusement devices, including video gaming terminals. It collects owner and business contact details, tax identification, terminal and operator information, license history, compliance acknowledgments, payment details, and the applicant’s signature; applicants must include the listed Gaming Board license copies and applicable fees.

Who needs it

A business owner or applicant seeking an annual South Roxana amusement license for devices at an establishment should file it.

How to submit it

Submit the application and required license copies to the Clerk’s Office, 211 Sinclair Avenue, South Roxana, IL 62087. Applications and fees are due annually on or before May 1; payment options listed are check, money order, or online payment.

About notarization

This application is signed and dated without a notary; the signer certifies the information and agreement directly on the form.

How to submit this form

1
Download The Application
Download the South Roxana Amusement License Application PDF.
2
Complete The Application
Enter applicant and business details, device and operator information, license history, compliance acknowledgments, payment details, and sign and date.
3
Gather Required Attachments
Attach valid Gaming Board license copies for the licensed establishment and terminal operator, and calculate applicable device fees.
4
Submit To The Clerk’s Office
Submit the application, attachments, and fees to the Clerk’s Office at 211 Sinclair Avenue, South Roxana, IL 62087, by May 1.

Frequently asked questions

Do I need a notary for this application?: No. This application is signed and dated without a notary; the signer certifies the information and agreement directly on the form.
How do I submit the amusement license application?: Submit the application, required Gaming Board license copies, and applicable fees to the Clerk’s Office at 211 Sinclair Avenue, South Roxana, IL 62087.
What documents must accompany the application?: Include copies of valid Illinois Gaming Board licenses for both the licensed establishment and the terminal operator, along with applicable fees for each amusement device.
When are applications and fees due?: Applications and fees are due annually on or before May 1. The form states that all applicable fees must be paid in full before licenses are issued.

Need something notarized?

This Amusement License Application doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.