Permit Number: 25GC_________
New Golf Cart Permit Application
City of Effingham, 201 E. Jefferson Ave., Effingham, IL 62401
PURPOSE:
This application is for a permit to operate a “Golf Cart” on the City of Effingham streets and alleys in accordance with the City of Effingham Ordinance No. 057-2022.
Applicant Information:
Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Email
*
example@example.com
Birth Date
*
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Primary Phone Number
*
Please enter a valid phone number.
Other Phone Number
Please enter a valid phone number.
Driver's License Number
*
Driver's License Expiration Date
*
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Golf Cart Information:
Make
*
Model
*
Color
*
Serial Number
*
Number of Seat Belts
*
Liability Insurance Carrier
*
Insurance Policy Number
*
Sticker Fee: $50.00 ($40.00 for ages 62 years and older)
To be paid in person at the Effingham Police Department on or after September 26, 2025
Payment
Cash
Money Order
Check
If paying by check, what is your check number?
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Golf Cart Inspection Checklist
Required safety features for operating a golf cart in the City of Effingham
To be completed by inspector at time of golf cart inspection:
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Please upload a photo of your current driver's license.
*
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Please upload a copy of your current liability insurance policy as required under 625 ILCS 5.0/7-601, specifically for vehicle to be operated within the City of Effingham:
*
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Please upload a copy of your original executed Unconditional and Full General Release of Liability, Waiver, Discharge, and Covenant Not to Sue:
*
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Get help
Please see the City of Effingham’s website at www.EffinghamIL.com to review the complete Golf Cart ordinance (057-2022). A map of the city and all allowable golf cart routes and crossings can also be found on the website. You may also contact Effingham Police Department for more information at EPD@EffinghamIL.com or call 217-347-0774, extension 5315. To complete the application process and receive your permit sticker, please bring a check, money order or cash in person to Effingham Police Department, 110 S. 3rd Street, Effingham, IL 62401, weekdays between 8:00 a.m. and 4:00 p.m.
PERMIT EXPIRATION DATE: September 30, 2026
I hereby acknowledge receipt of a copy of the City of Effingham Ordinance No. 057-2022 and affirm that all information provided above to be true and factual.
Date and Time
Please verify that you are human
*
Signature
For office use only:
Approved
Denied
Inspector Signature and ID Number
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