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Mechanical Amusement License Application

Fees:  $150.00 - one year license

$75.00 - six month license

"Mechanical Amusement Device" is any machine or device which, upon insertion of a coin, slug, or token, operates for use as a game, contest, or amusement, and which does not contain a pay-off device for the return of slugs, money, coins, checks, tokens, or merchandise.  (Examples:  pool tables, video games, jukebox, dartboard, karaoke)

 

Some amusement machines such as video poker and coin pushers are deemed illegal.  Please contact your local police department if you have questions.

 

Under the provisions of Chapter 150 of the Municipal Code, I hereby apply for a Mechanical Amusement Device license for said business to be conducted on the following described premises within the Village of Fox Crossing:

Address of Licensed Premises
Address of Licensed Premises
Street Address
City
State/Province
Zip/Postal
Relationship to Property:
Applicant Address
Applicant Address
Street Address
City
State/Province
Zip/Postal
Applicant Name
Applicant Name
First
Last

I, the undersigned, hereby acknowledge that I have agreed to be bound by all items and provisions of Village ordinance.  I further acknowledge that this license, if granted by the Village of Fox Crossing, does not sanction or condone the use of any illegal gambling machines or devices, whether illegal or modified or as used, or the making/giving of any payout, compensation, reward, or other consideration based on the use of any legal or illegal gambling machine or device could result in criminal prosecution by municipal or other law enforcement authorities.