Nevada > Statewide > Nevada Gaming Commission And State Gaming Contol Board > Enforcement Division

Listed Patron Approval ENF-4 - Nevada

Listed Patron Approval Form. This is a Nevada form and can be used in Enforcement Division Nevada Gaming Commission And State Gaming Contol Board Statewide .
 Fillable pdf Last Modified 9/23/2003
Get this form for FREE as a print-only pdf

GAMING CONTROL BOARD REGULATION 22.061 LISTED PATRON APPROVAL PERSONAL INFORMATION Patron Name Date of application Other names patron has used or been known by Date of Birth Social Security Number Home Address Place of Birth Mailing Address City Home Phone Driver License Number State Expiration Date Current Employment State Zip City Business Phone State Zip Previous Driver's Licenses From Other States Employment Verified by Casino Yes Initials No PATRON'S BOOK WAGERING ACTIVITY AND ALL WAGERING ACCOUNT NUMBERS Account # Activity (Date opened ­ Total handle during last 12 month period) WHY DO YOU DESIRE TO HAVE THIS PERSON APPROVED AS A LISTED PATRON? TO THE BEST OF YOUR KNOWLEDGE IS THIS PATRON INVOLVED IN ILLEGAL WAGERING ACTIVITY? YES___________NO _____________ CASINO REPRESENTATIVE'S SIGNATURE _________________________________________________________________ TITLE _______________________________________ DATE_____________ PHOTO ENF 4 (12-98) American LegalNet, Inc.
Link/Embed this Document

Popular Searches

  1. Form Interrogatories-General
  2. Preliminary Change of Ownership Report
  3. Decree of Dissolution of Marriage
  4. proof of service of summons
  5. Petition to Expunge
  6. Income and Expense Declaration
  7. writ of replevin
  9. Notice and Acknowledgment of Receipt
  10. proof of claim

Bookmark and Share