Municipal License - Arcade Application

Municipal Code, Chapter 230

Application Process

Complete the following application accurately - printable versions are also available or in the Clerk's Office.
If you are unsure about how to respond to any questions on this form, check with the City Clerk for clarification.
$50 License Application fee is required prior to obtaining the license - online payments are accepted.

Review of your application

The Richland Center Police Department will perform a background check to verify the information you have provided.
The city may require that additional information, appropriate to the specific type of license requested, be submitted with this application or as a supplement to this application prior to consideration of license issuance.
City Council will review your application for approval at the next regular monthly meeting.
- If you are asked to appear before the council but choose not to do so, your application may be denied.

Supporting Documents

Arcade Municipal License Application (691 KB)

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Agent Information

Last Name *

First Name *

Middle Initial *

Date of Birth *

edit-submitted-agent-information-date-of-birth-month

edit-submitted-agent-information-date-of-birth-day

edit-submitted-agent-information-date-of-birth-year

Driver's License Number *

Residence Street Address *

City, State, Zip Code *

Mailing Address

if different than above

Phone Number *

Email *

Other Identifying Names

maiden name or aliases, etc.

Location of Machine Operations

Business Name *

DBA Name

if applicable

Street Address *

City, State, Zip Code *

Phone Number *

Business Email

Arcade Machine Types *

please list all if multiple types

Additional Person(s) who shall be in charge of the operation

Name

Last, First & Middle Initial

Name

Last, First & Middle Initial

The undersigned, by signing this application, hereby authorize and consent to such inquiry and/or investigation as the City of Richland Center deems necessary to determine whether this applicant and/or the application meets all requirements of the ordinances of the City for the issuance of said license. I further certify I understand that any material falsification in the application may be basis for denial of the application or the revocation of any license issued by the city pursuant to this application.

Applicant Virtual Signature *

City Clerk / Treasurer

Contact Information

Address:
City of Richland Center Municipal Building
450 South Main Street
Richland Center, WI 53581

Phone:
(608) 647-3466

Fax:
(608) 647-8360

Hours:
Monday - Friday:

8:00 AM to 4:30 PM

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