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  1. RAFFLES REPORT 
    (MUST BE COMPLETED WITHIN 30 DAYS OF CONCLUSION OF RAFFLE)

  2. RECORD OF RECEIPTS
  3. Organizations holding several drawings in the same month need to submit only one Report per month.
  4. RECORD OF DISTRIBUTION
  5. I declare this raffle report has been examined by me, and to the best of my knowledge is true, correct, and complete.
  6. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  7. Per the Illinois Raffles and Poker Run Act, records must be retained for a minimum of three years. Gross receipts from the operation of a raffle shall be segregated from other revenues of the organization, including bingo gross receipts, and placed in a separate account. The person who accounts for gross receipts, expenses, and net proceeds from the operation of raffles shall not be the same person who accounts for other organizational revenues.
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  9. This field is not part of the form submission.