Application for Amusement License Application for Amusement License Name and Address of Applicant * Name and Address of Applicant Name and Address of Applicant Name and Address of Applicant City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Buisness Name and Address * Buisness Name and Address Buisness Name and Address Buisness Name and Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * Phone Number of Amusement Devices per location * Description of Devices * Amusement Fee Regular Amusement Fee $35 Shooting Parlor Fee $60 Notice: THE UNDERSIGNED HAS KNOWLEDGE OF GENESEO ORDINANCE NO. 1518, DATED MARCH 9, 1993, REGARDING AMUSEMENT LICENSES WHICH WAS CODIFIED AND APPROVED BY ORDINANCE NO. 1953 ON OCTOBER 13, 2009. If you are human, leave this field blank. Submit
