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Illinois Department of Revenue

RCG-2 List of Charitable Games Workers

Read this information ﬁrst

In order for the individuals listed in Step 3 to participate in the management or operation of your charitable games events, all requested information must be complete, and we must receive this form at least 14 days prior to the earliest event date listed in Step 2. In addition, the president and secretary listed on Form RCG-1, Charitable Games Application for License, must sign this form.

Step 1: Identify your organization

Organization name: ________________________________________ Charitable games license number: CG - ______________

Step 2: Identify the event dates

This charitable games workers list is for the following charitable games event dates:

____ / ____ / ________			____ / ____ / ________			____ / ____ / ________			____ / ____ / ________
Month	Day	Year	Month	Day	Year	Month	Day	Year	Month	Day	Year
____ / ____ / ________			____ / ____ / ________			____ / ____ / ________			____ / ____ / ________
Month	Day	Year	Month	Day	Year	Month	Day	Year	Month	Day	Year

Step 3: Identify those who will participate in your events

List below the members, employees, or volunteers of your organization who will participate in the management or operation of your charitable games events. If more than 20 individuals will be participating in such activities, additional Forms RCG-2 must be completed. Setting up, cleaning up, selling concessions, working in the kitchen, or providing security for persons or property does not constitute participation in the management or operation of a charitable games event.

Note: The following individuals are ineligible to work charitable games events: professional gamblers, persons who have been convicted of a felony within 10 years of the date your Form RCG-1, Charitable Games Application for License, was ﬁled, persons who have been convicted of any violation of Article 28 of the Criminal Code of 1961, or persons who are employed by or have any interest in any person, ﬁrm, or corporation that holds a charitable games provider’s or supplier’s license.

1	_______________________________________________			5	_______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
2	_______________________________________________			6	_______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
3	_______________________________________________			7	_______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
4	_______________________________________________			8	_______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth

RCG-2 front (R-01/14)

Step 3: Identify those who will participate in your events (continued)						CG - ______________
9	_______________________________________________ 15 _______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
10	_______________________________________________ 16 _______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
11	_______________________________________________ 17 _______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
12	_______________________________________________ 18 _______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
13	_______________________________________________			19	_______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth
14	_______________________________________________			20	_______________________________________________
	Name				Name
	_______________________________________________				_______________________________________________
	Number and street				Number and street
	_______________________________________________				_______________________________________________
	City	State	ZIP		City	State	ZIP
	______ - ____ - ________	____ / ____ / ________			______ - ____ - ________	____ / ____ / ________
	Social Security number	Date of birth			Social Security number	Date of birth

Step 4: Sign below

I hereby certify under penalties of perjury that the individuals listed above are bona ﬁde members, volunteers, or employees of the licensed organization; that none of them have participated in the management or operation of more than 12 charitable games events within the calendar year; and that none of them will receive any remuneration or compensation directly or indirectly for participating in the management or operation of any charitable games event conducted by the licensed organization.

President’s signature _______________________________________	Date	____ / ____ / ____
Secretary’s signature _______________________________________	Date	____ / ____ / ____

This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is ﬁled. Disclosure of this information is required.

Failure to provide information may result in this form not being processed and may result in a penalty.

RCG-2 back (R-01/14)

Question	Answer
Form Name	Form Rcg 2
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	RCG 2 rcg 2 form

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