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Annual State License Fee Report Basd On Number Of Games To Be Operated NGC-02 - Nevada
| Annual State License Fee Report Basd On Number Of Games To Be Operated Form. This is a Nevada form and can be used in Tax And License Division Nevada Gaming Commission And State Gaming Contol Board Statewide . |
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NGC-02 (10-17-11) NEVADA GAMING COMMISSION Annual State License Fee Report Based on the Number of Games to Be Operated (NRS 463.380) Filing Deadline: Account No., Name, Address, Zip Code For Office Use Only Account No.: Legal Name: Trade Name: Address: City, State, Zip: Please correct if in error Please correct if in error Check Number Batch Number Entry Number INSTRUCTIONS This report must be filed and fees paid PRIOR to placing games into operation. If games are to be added AFTER the beginning of the calendar year, you must file a supplemental NGC-02. State law requires that a penalty will be charged for late payments. The total number of games to be operated must be included on this report. (DO NOT INCLUDE POKER OR PAN TABLES AS THEY ARE EXEMPT FROM THIS FEE) This report must be filed and fees paid prior to the addition of games during the calendar year. If you have any questions, please contact the State Gaming Control Board, Tax and License Division. LICENSE FEE SCHEDULE One game Two games Three games Four games Five games Six or seven games ........... ........... ........... ........... ........... ........... $ 100 200 400 750 1750 3000 8 thru 10 games ........... 11 thru 13 games ........... 14 thru 16 games ........... 17 plus games ........... for each game in excess of 16 $ 6000 650 1000 16,000 total each each total + 200 Annual Renewal (Due Dec. 31) Line 1. Line 1a. If this is your Annual Renewal filing, list the number of games to be licensed: Include Keno, Bingo, Race Book and Sports Pool. Do not include Poker or Pan License fee due for Original filing NRS 463.380: Amendments (for game additions during the calendar year) A. Enter date of addition: Line 2. Line 2a. Line 2b. Line 2c. Line 3. List the number of games licensed before this addition List the number of games to be added on the above date Total number of games licensed after addition License fee due for Amended Filing NRS 463.380: Penalty for late payment NRS 463.270(5): Enter number of days late: A. Less than 10 days late: 25% of the amount due, but not less than $50.00 and not more than $1,000.00. 25% of the amount due, but not less than $50.00 and not more than $5,000.00. B. Ten or more days late: Line 4. Total amount due: (Total of lines 1a or 2c and 3A or 3B) Please make remittance payable to: NEVADA GAMING COMMISSION Return to State Gaming Control Board, Tax and License Division, PO Box 8004, Carson City, NV 89702-8004. Pursuant to NRS 353.1467, payments made to the State, in the aggregate, that amount to $10,000.00 or more must be sent electronically. I, certify and declare under the penalties of perjury that I am the of the business named above; that this is a true, correct and complete (Owner, Partner, President, Treasurer, Other-describe) report to the best of my knowledge, information, and belief; and that this application and report is made with the knowledge and consent of all other individuals licensed. Dated Person to contact regarding this report: Name: Signed Phone: American LegalNet, Inc. www.FormsWorkFlow.com RETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS
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