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Regulation 6.130 Count Personnel List For Group I Licensees - Nevada

Regulation 6.130 Count Personnel List For Group I Licensees Form. This is a Nevada form and can be used in Audit Division Nevada Gaming Commission And State Gaming Contol Board Statewide .
 Fillable pdf Last Modified 9/23/2003
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NEVADA GAMING CONTROL BOARD REGULATION 6.130 COUNT PERSONNEL LIST FOR GROUP I LICENSEES Page ____ of ____ Licensee:_______________________________________________ Location No.: ________________ Quarter Ending: __________________ (Mo./Day/Yr.) Participates in: Tabl Slots e (Soft) (Soft) Slots (Coin) Allowed in Count Room Only (1) Ownership Interest (2) Employee Name 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Job Position SS# Relationship (3) 1. For those individuals who are not count team members, but are allowed access to the count room during the count, indicate with "TS" (table soft), "SS" (slots soft) or "SC" (slots coin). 2. Disclose if count team member has any ownership interest in licensed operation. 3. Disclose any relationship (by blood or marriage) a count team member has with other count team members, any interest holder or employee of the gaming establishment. (Indicate name and relationship in space provided or in attachment.) Submitted by _________________________________ Phone Number ___________________________ American LegalNet, Inc.
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