APPLICATION INSTRUCTIONS FOR AN AMUSEMENT DEVICE OWNER/DISTRIBUTOR LICENSE

Who Needs an Amusement Device License?

Companies leasing amusement devices to businesses in the City of Greenfield should apply for an Amusement Device Owner/Distributor license. There is an additional fee required for a tag for each machine.

If a Greenfield business owns the amusement device(s), the business owner should apply for a tag for each machine he/she owns.

Requirements

Video gambling machines are not permitted in any establishment issued a Class A, Class B, Class C or license of any combination thereof.

Application Process

Submit the following:

Original Application for an Amusement Device Owner/Distributor license
$150 License Fee – once the application is submitted, you will be directed to your BS&A online account to pay the invoice.
$40 for each tag requested in Section 4 of the application

**Please note when paying for your license online with a credit card, there will be a transaction fee of 2.5% with a minimum of $2.00 added to your payment** If you want to avoid the fee, you can mail a check to:

City Clerk's Department
7325 W. Forest Home Ave., Rm, 102
Greenfield, WI 53220

Deadline for Application Submittal

New Amusement Device License/Tag: Applications must be approved by the Greenfield Common Council. Applications must be submitted at least 13 days prior to a Council meeting to be eligible for consideration. The Council meets on the 1^st and 3^rd Tuesday of each month. From June through September, the Council meets only once per month (on the 3^rd Tuesday of each month).

Renewal of current Amusement Device License/Tag: Applications must be approved by the Greenfield Common Council. Applications should be submitted and paid for by April 15.

License Period

License year begins August 1 and ends on July 31st of the following year. Once a license approved, you will be notified via email that you can access it for printing through your BS&A online account.

Adding Tags

If a Distributor wishes to add additional tags during the year, another application must be submitted. Council approval is not required. Additional tags are $40 each.

Renewal Applicants

License renewal notices are generally emailed mid to late April of each year and specify the deadline to renew an Amusement Device Owner/Distributor license (usually early June).

Posting of License Required

Distributors located in Greenfield must post their licenses in a conspicuous place on the premises. This requirement also applies to other licenses a business may hold (Entertainment license, Cigarette license, etc.). A tag should be affixed to each device.

Change of Business

If a business changes ownership, the Distributor must apply for new tags listing the name of the new business.

APPLICATION FOR AN AMUSEMENT DEVICE OWNER/DISTRIBUTOR LICENSE

7325 W. Forest Home Ave., Room 102

Greenfield, WI 53220

Telephone: (414)-329-5219

Fax: (414)-543-0591

The undersigned hereby respectfully makes application to the Common Council of the City of Greenfield for an Amusement Device Owner/Distributor License under the provisions of Section 13.08 of the City of Greenfield Municipal Code.

Are you lawfully authorized to work in the United States?

Yes

Are you an individual applicant or the agent of a corporation or LLC?

Yes

If yes, please answer the following.

Name of Applicant (First, Middle, Last)

Phone Number

Email Address

Are you a corporation, LLC, or partnership?

Yes

If yes, please answer the following.

Name of corporation, LLC, or Partnership

Phone Number of corporation, LLC or partnership

Are you a Partnership?

Yes

If yes, please answer the following.

Name of partner #1 (First, Middle, Last)

Phone Number

Are you lawfully authorized to work in the United States?

Yes

Name of partner #2 (First, Middle, Last)

Phone Number

Email Address

Are you lawfully authorized to work in the United States?

Yes

LIST NAME, ADDRESS, AND NUMBER OF TAGS REQUIRED FOR EACH LOCATION

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Name

Address

Number of Tags

Consent

I hereby consent to the inspection of our records and amusement devices to determine ownership and character of same.

Consent

Under penalty of law, I swear that the information provided in this application is true and correct to the best of my knowledge.

Consent

The undersigned acknowledges and sets forth that he/she is not placing video gambling machines in any establishment issued a Class A, Class B, Class C, or license of any combination thereof.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.