Multi Jurisdiction License Form – Fill Out and Use This PDF

The Multi-Jurisdiction License form serves as a vital application for racehorse or greyhound owners who wish to participate in races across various jurisdictions under the Racing Commission International's (RCI) Multi-Jurisdiction Licensing Program. This program simplifies the process of applying for racing licenses in multiple locations by offering a consolidated application form, specifically designed for owners not seeking other types of licenses such as trainers or drivers. To ensure all required documents and information are accurately provided and to explore the list of participating jurisdictions and fee schedules, interested individuals are encouraged to meticulously review the last page of the application form. For convenient access to the application and to become part of the RCI Multi-Jurisdiction Licensing Program, click the button below.

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Multi Jurisdiction License Form PDF Details

Embarking on a journey through the intricate world of horse and greyhound racing ownership across multiple states presents its unique set of challenges and requirements. Central to navigating this complex arena is the Multi-Jurisdiction Racing License Owner’s Application, a cornerstone for owners aiming to engage in racing activities across different jurisdictions. This program, facilitated by the RCI (Racing Commission International), simplifies the process by offering a unified application that avoids the redundancy of filing separate applications for each jurisdiction. The form caters exclusively to owners, distinct from other race-related licenses such as trainers or drivers, and outlines a comprehensive series of questions ranging from personal identification, including marital status and emergency contact information, to more detailed inquiries concerning previous licensing history, legal confrontations, and current racing engagements. Importantly, the form mandates disclosure of any criminal offenses and financial responsibilities like child support, providing a thorough background check to ensure the integrity of the sport. Additionally, it emphasizes the importance of compliance with both local and national regulations governing the sport, underscoring the privilege rather than right to participate in racing. With specific sections dedicated to the ownership and leasing details of horses or greyhounds, alongside requirements for worker’s compensation insurance, this form acts as a crucial tool for ensuring that all participating entities meet the necessary standards set forth by various racing jurisdictions, ultimately aiming to maintain the sport's integrity and fairness.

Question	Answer
Form Name	Multi Jurisdiction License Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	horse racing owners license, arkansas racing license application, multi jurisdiction blank, nys racing license renewal application

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Multi-Jurisdiction

Racing License

Owner's Application

OFFICE USE ONLY

New or Renewal

Date

License #

F.P.

Total Fees

Receipt/

Tran ID #

(status)

Cash

Check #

M.O. #

Clerk

Approved

by:

Welcome to the RCI Multi-Jurisdiction Licensing Program!

As a racehorse or greyhound owner who may wish to participate in several different racing jurisdictions, you are eligible to apply for multi-jurisdiction license privileges through the RCI Multi-Jurisdiction Licensing Program.

This form is only for those owners who will not be applying for any other type of license (ie, trainer, driver, etc.) If you will be applying for another type of license, please contact those jurisdictions for an application. Some racing commissions may require additional information from you. If so, you will be contacted by that commission and requested to submit addendums to this form.

Please refer to the last page of this form for instructions, list of participating jurisdictions and fee schedule.

Check

Breed(s)

Thoroughbred

Standardbred

Quarter Horse

Greyhound

Other

1. Applicant Name

Last

First

Middle

Maiden

2.Have you ever used an assumed name or been known by another name or been licensed under an assumed or different name? If yes, give name(s)

Yes

3. Marital status? Married

Single

Divorced

Widowed

If married, full name of spouse, including maiden name:

Last licensed in:

Year

Type of License

Name of State

5. List latest dates fingerprinted and what states printed you:

In what State(s)

Month &Year(s) Printed

Telephone numbers: (

)

(

)

(

)

Home #

Business #

Fax #

Person to be notified in case of emergency:

Telephone: (

)

Social Security No.*

Sex Height Weight

Color Hair

Color Eyes

Date of Birth Age

Social Insurance No. (Canadians)

* Providing Social Security Number may be voluntary and will be used as a secondary identifier; however, some jurisdictions do mandate you provide it.

Mo Day Year

9. Are you a U.S. Citizen?	Yes	No

Place of Birth

City/State

If no, what country are you a citizen of? Immigration I.D. number (if applicable) A-

10. USTA/SC Membership Number		(If applicable)	USTA/SC Membership Exp. Date:

11.	Permanent mailing address:

	(at which service all papers may be made upon you)		Street

		City	State/Province	Postal Zip/Country
12.	Local address:
12.	Local address:		Street
			Street

		City	State/Province	Postal Zip/Country

13. Give the following information relative to your current employer. If self-employed, so indicate:

Employment Dates

Name of Employer

Address (Street, City, State, Zip)

14. List your occupation here:

If self-employed, list type of business:

Questions 15 - 18 MUST be answered "yes" or "no". Give details in space provided.

15.

a.Has your license (or your spouse's license) ever been denied, suspended or revoked	Yes	No
or is a complaint pending in any racing jurisdiction?	Yes	No
or is a complaint pending in any racing jurisdiction?

b. Have you ever been fined $100 or more or discharged, expelled or ejected from any	Yes	No
race track by any racing official, or commission?	Yes	No
race track by any racing official, or commission?

c. Have you ever had any permit or license denied, suspended or revoked by any federal,	Yes	No
state or local government agency?	Yes	No
state or local government agency?

Date

State

Track

Specific Violation(s)

16. a. Have you (or your spouse) ever (a)		pleaded guilty, pleaded nolo contendere, been
	found guilty or been convicted or (b) forfeited bail or been fined for any criminal			Yes	No
	offense, eitherfelony ormisdemeanorincluding driving under the influence of alcohol			Yes	No

	and/or drugs?
	b. Are there now any indictments or complaints pending against you (or your spouse) for			Yes	No
	any public offense?			Yes	No
	any public offense?
	c. Are you (or your spouse) currently on	parole or probation?		Yes	No
	If yes, probation ends:		(please indicate month, day and year)	Yes	No
	If yes, probation ends:		(please indicate month, day and year)

Date of Arrest State

Arresting Agency

Offense

Outcome/Sentence

17. Are there any outstanding court-imposed civil judgements against you? If so, attach an explanation. Yes No

18 a. Are you under an obligation to pay child support in any jurisdiction? b. If yes, are you four (4) months or more in arrears?

19.If you will be appointing an Authorized Agent, please list agent's name here:

20.Number of horses or greyhounds in training?

Yes No

21.Statement of Ownership (including questions 22 & 23)

List only horses or greyhounds that you plan to race this year owned wholly or in part by you or leased to you. If leased, or in partnership, so designate.

Horse/Greyhound Name Age Trainer's Full Name

Ownership Name on Registration Papers

%Breed

Owned (T/S/Q/G)

If additional space is needed in relation to any of the questions above, please use a separate sheet of paper and submit it with this form.

22.If you listed a Stable Name, or a Corporation Name or any other legal entity as owner of a horse or greyhound underStatementofOwnership(seeQuestion21),pleasetellusabouttheindividualpersonsunderthatnameholding any interest in those horses or greyhounds. Please check with each state you plan on racing in to determine if they require a separate Stable Name registration form be filed, in addition to this application.

Name

Address (street, city, state & zip)

	Name of	%


	Horse or Greyhound	Owned

23. Is your horse leased? *	Yes	No
* A copy of the lease agreement(s) must be attached and submitted
			Name of Lessor (owner)	Name of Lessee
with this application. NOTE: Virginia & Michigan require all leases be notorized.			Name of Lessor (owner)	Name of Lessee

24. Are you obligated to have worker's compensation insurance covering employees in connection with racing? If yes, indicate the following:

Company Name*

PolicyNumber

Expiration Date

Name of Policyholder

* (A copy of your worker's compensation certificate of insurance must be attached and submitted with this application.)

25. Are you a New York State public employee, elected public official, political party officer, or police officer?

Yes	No IF YES, contact the NYS Racing Board or www.racing.state.ny.us for Form PE-1.

Inmakingthisapplicationforalicensetoparticipateinracing,itisunderstoodthataninvestigativereportmaybemadewherebyinformation isobtainedthroughpersonalinterviewswiththirdparties,suchasfamilymembers,businessassociates,financialsources,friends,neighbors, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, which may be applicable. Youhavetherighttomakeawrittenrequestwithinareasonableperiodoftimeforacompleteandaccuratedisclosureofadditionalinformation concerning the nature and scope of the investigation.

Bysubmittingthisapplication,I,theundersigned,dohereby(1)agreetoabidebytherulesandregulationsofthepari-mutuelregulatoryagency, the laws of the United States of America, Canada, state/provincial government, municipalities and other subdivisions thereof; and (2) agree to abide by any provisions regarding search and seizure which may be contained in any of the above-mentioned laws, rules and regulations, and I consent and waive any right I have to object to the search, within the grounds of a racetrack or racing association, of any premises or vehicle which I may occupy or control or have the right to occupy or control and of my person, property and effects and the seizure of any article the having of which may be forbidden.

Iunderstandthatparticipationinracingisaprivilege,notaright,thatanylicenseissuedpursuanttothisformissubjecttoconditionsprecedent assetoutintheRulesofRacing,andthatmyfailuretocomplytherewithshallbegroundsforimmediatevoidanceorrevocationofsuchlicense. By acceptance of said license, I agree to abide by the Rules of Racing and rulings or decisions of the Stewards with the knowledge that rulings or decisions of the Stewards shall remain in force until reversed or modified only by the authorized regulatory agency.

Ihereby certify that, under the penalty of perjury, I have read the foregoing form and affirm that every statement contained therein is true and correctly set forth. I do hereby agree that my license may be removed at any time for misstatements or omissions in the foregoing form. I also agree to abide by and obey the rules and regulations and conditions of the authorized regulatory agency in the jurisdictions in which I am granted a license.

Iexpresslyagreetobesubjecttothesubpoenapowersoftheauthorizedregulatoryagencyorawrittenrequestissuedinlieuofasubpoena and to provide the agency with any and all such information or documents which it may so request. This agreement shall extend to anything which relates to any matter which is the subject of an agency hearing or investigation.

Illinois Applicants: The Illinois Racing Board may refuse to issue or may suspend the occupation license of any person who fails to file a return, or to pay the tax, penalty or interest, as required by any tax Act administered by the Illinois Department of Revenue until such time as the requirements of any such tax Act are satisified.

New York Applicants: The authority to request personal information from you, including numbers such as Federal social security and Federal employer identification numbers, and the authority to maintain such information is found in Section 5 of the New York Tax Law. Disclosure of this information by you is mandatory. The principal purpose for which the information is collected is to enable the Department of Taxation and Finance to identify individuals, businesses and others who have been delinquent in filing tax returns or who may have understated their tax liabilities and to generally identify persons affected by the taxes administered by the Commissioner of Taxation and Finance. The information will be used for identification and licensing purposes and for any other purpose authorized by the New York State Racing and Wagering Board which may include use in a multi-state licensing database. An investigative consumer report may be requested in connection with this application. Your signature authorizes the Racing and Wagering Board to obtain such a report. You may ask in writing whether or not a report was requested and the name and address of the consumer reporting agency used.

Please be sure to make copies of this form before signing!

Signature of Applicant		Date
E-mail Address:
		(Optional)

Notary Public

Only necessary for a Florida license.

Subscribed and sworn to before me this

Day

day of MonthYear . State of: County of:

Notary Public

Expiration Date

If additional space is required for any of the above questions, please use a separate sheet of paper and submit

it with this form.	3

Instructions for the RCI Multi-State Program

GENERAL INFORMATION. All race jurisdictions listed within the fee structure on the next page accept this license application form. For RCI fingerprintcards or additional information, contact RCI headquarters at (859) 224-7070 or visit www.arci.com. APPLICATIONS. Before signing, make a copy of this completed application form for each jurisdiction you’ll race in, then sign each copy with your original signature. Deliver or mail one signed copy and the applicable fee(s) to each jurisdiction where you seek an owner's license. You must send the application and applicable fees to each one; jurisdictions will not forward copies for you. FINGERPRINTS. SomeStatesrequirefirst-timelicenseestosubmitafingerprint card and an extra fee of $36. If you use an RCI fingerprint card, you only have to submit one fingerprint card to one listed jurisdiction. To have your fingerprint reports sent to the others, where you plan to race, mark those jurisdictions (up to nine) on the back of the RCI fingerprint card. You can be fingerprinted at a racetrack or by the local police or sheriff (bring an RCI fingerprint card with you; most racetracks have a supply). Renewinglicensees might be fingerprinted periodically, and will be advised by each jurisdiction. FEES. Participating jurisdictions’ licensing fees are listed on the next page, with directions to help you properly make out your check(s). WHERE TO MAIL. Completed fingerprints and a check or money order (no cash) may be mailed to the racing commission that requires your prints or where you plan next to race. A signed copy of this application and applicable license fee must accompany the completed fingerprint card and fee (for which a separate check may be required). Refer to the fee list schedule to calculate your fees. For RCI fingerprint cards and for further information you can contact RCI at (859) 224-7070 or www.arci.com.


	Jurisdictions and Fee Schedule
	(Code for Fees: O=Owner;		H=Harness; TB=Thoroughbred; Q=Quarter Horse; GH=Greyhound)



	Arkansas State Racing Commission	Indiana Horse Racing Commission		Michigan Department of Agriculture	Ontario Racing Commission
	Greyhound Division	at Indiana Downs		Office of Racing Commissioner	10 Carlson Court, Suite 400
	P.O.Box 2088	4425 N 200 West			Toronto, Ontario M9W 6L2 Canada
				P.O. Box 30773; Lansing, MI 48909
	West Memphis, AR 72303-2088	Shelbyville, IN	46176		Ph: 416-213-0520; Fax: 416-213-7827
				Ph: 517-335-1420; Fax: 517-241-3018
	Ph: 501-682-1467; Fax: 501-682-5273	Ph: 317-713-3350; Fax: 317-713-3355			New: O @ $132 ($CND)
				O @ $25 payable to State of Michigan
	O @ $30 payable to ASRC	O @ $35 payable to IHRC			RENEW: O @ $110 ($CND)
				Prints $36 payable to State of Michigan
	No Prints Required	Prints $36 payable to IHRC			No prints required
	Arkansas State Racing Commission	Iowa Racing and Gaming Commission		Mobile County Racing Commission	Pennsylvania HARNESS Racing Comm.
	Thoroughbred Division	One Prairie Meadows Dr., P.O. Box 1000
				P.O. Box 1886	P.O. Box 427
	P.O.Box 699	Altoona, IA 50009-0901
				Mobile, AL 36633	Meadow Lands, PA 15347
	Hot Springs, AR 71901	Ph: 515-967-1260; Fax: 515-967-1290
				Ph: 251-653-4820; Fax: 251-653-4850	Ph: 724-223-4585; Fax: 724-223-4305
	Ph: 501-682-1467; Fax: 501-682-5273	O @ $10 payable to IRGC (2 YR LIC)
				O @ $25 payable to MCRC
	O @ $30 payable to ASRC	Prints $36 payable to RCI or $46.25 payable			O @ $60 (Only offer 3 YR LICENSE)
		to IRGC		No Prints Required	Prints $40 on PA fingerprint card every 3 yrs
	No PrintsRequired
	California Horse Racing Board	Jamaica Racing Commission		Nebraska State Racing Commission	Puerto Rico Racing Sport Administration
	1010 Hurley Way, Suite 300	P.O. Box 309	Kingston 10, Jamaica	P.O. Box 95014	Administracion del Deporte Hipico Apartado
	Sacramento, CA 95825	Ph: 876-926-2727; Fax: 876-926-2207		Lincoln, NE 68509	P.O. Box 29156 65th Infanteria Station
					Rio Piedras, PR 00929-0156
	Ph: 916-263-6000; Fax: 916-263-6042	O @ $3,000 Jamaican dollars payable to		Ph: 402-471-4155; Fax: 402-471-2339
					Ph: 787-768-2005; Fax: 787-762-1105
	O @ $150 payable to CHRB (Only offer 3	JRC. Require 2 passport size photos		O @ $30 payable to NSRC
					NEW: O @ $150; RENEW: O @ $100; $400
	YR LICENSE) State Prints Only Required	No Prints Required		Prints $38 payable to NSRC	4-YR payable to PRRSA. No Prints Required
	Colorado Division of Racing Events	Kentucky Horse Racing Authority		New Hampshire Pari-Mutuel Commission	Texas Racing Commission
	1881 Pierce Street, Suite 108				8505 Cross Park Drive, Suite 110
		4063 Iron Works Parkway		57 Regional Dr., Suite 3
	Lakewood, CO 80214-1494			Concord, NH 03301-8518	Austin, TX 78754-4594
		Lexington, KY 40511-8434
	Ph: 303-205-2990; Fax: 303-205-2950			Ph: 603-271-2158; Fax: 603-271-3381	Ph: 512-833-6699; Fax: 512-833-6907
		Ph: 859-246-2040
	NEW: O @ $75 (incl. state and FBI prints)			H-O @ $25; GH-O @ $20; w/colors @ $25;	O @ $75 (1 YR LIC); $150 (2 YR LIC);

	($85 if State & RCI prints-RCI prints payable to RCI)	TB O @ $150 & H O @ $125 payable to		Criminal records check required - $25	$225 (3 YR LIC) payable to TXRC.
	RENEW: O @ $25. Pay all to CDRE, expt RCI prnts	KHRC. No Prints Required		All payable to NHPMC.	Prints $36 payable to RCI
	Delaware HARNESS Racing Commission	Louisiana State Racing Commission		New Jersey Racing Commission	Viginia Racing Commission
	2320 South Dupont Highway	320 North Carrollton Ave, Suite 2-B		P.O. Box 088	10700 Horsemen's Road
	Dover, DE 19901	New Orleans, LA 70119		Trenton, NJ 08625	New Kent, VA 23124
	Ph: 302-342-3008; Fax: 302-697-4748	Ph: 504-483-4000; Fax: 504-483-4898		Ph: 609-292-0613; Fax: 609-599-1785
					Ph: 804-966-7412; Fax: 804-966-7422
	O @ $50 (1 YR LIC); O @ $150 (3 YR LIC)	O @ $25 (1 YR LIC); O @ $75 (3 YR LIC); Colors		O @ $50 (1 YR LIC); $150 (3 YR LIC) pay-
					O @ $10 payable to VRC
	Prints $69 if processed through DHRC pay-	fee: 1 YR @ $25; 3 YR @ $75. All payable to		able to NJRC. One time NJ State prints
					Prints $37 on VA print card payable to VRC
	able to DHRC; $36 if sent payable to RCI.	LSRC. No Prints Required		$40 and RCI prints $36 payable to NJRC

	Delaware Thoroughbred Racing Comm.	Maine Harness Racing Commission		New Mexico Racing Commission	Washington Horse Racing Commission
	777 Delaware Park Blvd	28 State House Station, Derring Building		4900 Alameda Boulevard NE	6326 Martin Way, Suite 209
	Wilmington, DE 19804	Augusta, ME 04333-0028		Albuquerque, NM 87113-1736	Olympia, WA 98516
	Ph: 302-994-2521, x 7258; Fax: 302-993-8949				Ph: 360-459-6462; Fax: 360-459-6461
		Ph: 207-287-3221; Fax: 207-287-7548		Ph: 505-841-6400; Fax: 505-841-6413
	O @ $50 (1 YR LIC); O @ $150 (3 YR LIC)	O @ $35 payable to MHRC		O @ $100 (1 YR LIC) O @ $120 (3 YR LIC)	O @ $226 payable to WHRC (includes
	Prints $69 if processed through DTRC pay-				$150 payment for Worker's Com, $66 lic fee, $10
		No Prints Required		payable to NMRC. Prints $36 payable to RCI
	able to DTRC; $36 if sent payable to RCI.				State of WA fingerprint fee - {required every 3 yrs})

*Florida Division of Pari-Mutuel Wagering		Maryland Racing Commission		New York State Racing and Wagering Brd	West Virginia Racing Commission
	1940 North Monroe Street	300 E Towsontowne Boulevard		1 Broadway Center, Suite 600	106 Dee Drive
	Tallahassee, FL 32399-1037	Towson, MD 21286		Schenectady, NY 12305-2553	Charleston, WV 25311
	Ph: 850-488-9130; Fax: 850-488-0550
		Ph: 410-853-1674; Fax: 410-8531668		Ph: 518-395-5400; Fax: 518-347-1439
	O @ $40 (1YR LIC); $120 (3 YR LIC) pay to				Ph: 304-558-2150; Fax: 304-558-6319
	DBPR/PMW. If Florida prints used, print	NEW: O @ $50; RENEW: O @ $25		NEW: O @ $210.50 - includes print fees.	O @ $15.00 payable to WVRC; Prints $36
		Call for other Charges; State Prints Only -		RENEW: O @ $50/year up to 3 consec. yrs.
	fee is $47 payable to DBPR/PMM. If RCI
					payable to WVRC. Send Apps to Track.
	prints used, print fee $36 payable to RCI	payable to CJIS		2 self photos. All payable to NYSRWB

	Illinois Racing Board	Massachusetts State Racing Commission		Ohio State Racing Commission
	100 West Randolph Street, Suite 7-701	1 Ashburton Place, Room 1313		77 South High Street, 18th Floor
	Chicago, IL 60601	Boston, MA 02108		Columbus, OH 43215-6108
	Ph: 312-814-2600; Fax: 312-814-5062	Ph: 617-727-2581; Fax: 617-227-6062		Ph: 614-466-2757; Fax: 614-466-1900
	O @ $25 payable to IRB; Prints $45	TB: O & H: O @ $30 payable to MSRC		O @ $50 payable to OSRC
	Illinois State/FBI fingerprint card required.	No Prints Required		Prints $36 payable to OSRC

* Use as a FLORIDA Application Requires the Applicant's signature to be Notorized.

NRC Multi Interactive App 6-12-09

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4. Filling out Have you or your spouse ever a, please indicate month day and year, Yes No, Yes No, Date of Arrest State Arresting, OutcomeSentence, Are there any outstanding, Yes No, a Are you under an obligation to, b If yes are you four months or, If you will be appointing an, Yes, Yes, Number of horses or greyhounds in, and Statement of Ownership including is vital in the next section - be sure to don't hurry and take a close look at every field!

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