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

6. Organization Name
8. Address
9. Phone
11. RECORD OF RECEIPTS
13. Gross Receipts:
14. Expenses:
15. Net Proceeds:
17. Organizations holding several drawings in the same month need to submit only one Report per month.
19. RECORD OF DISTRIBUTION
21. Winner Name
22. Address
24. Item/Value
25. Date Awarded
27. Winner Name
28. Address
30. Item/Value
31. Date Awarded
33. Winner Name
34. Address
36. Item/Value
37. Date Awarded
39. Winner Name
40. Address
42. Item/Value
43. Date Awarded
45. Winner Name
46. Address
48. Item/Value
49. Date Awarded
51. Treasurer Name
52. Date
54. I declare this raffle report has been examined by me, and to the best of my knowledge is true, correct, and complete.
56. 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.

    1. I agree.
58. Treasurer Electronic Signature*
59. Date*
61. 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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63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field