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Report Of Quarterly State Gaming License Fees NGC-15 - Nevada
| Report Of Quarterly State Gaming License Fees 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-15 (Rev. 10-17-11) NEVADA GAMING COMMISSION NONRESTRICTED LICENSEES ONLY REPORT OF QUARTERLY STATE GAMING LICENSE FEES Filing Deadline: Account No., Name, Address, Zip Code For Office Use Only Account No.: Legal Name: Trade Name: Address: City, State, Zip: SECTION I QUARTERLY RENEWAL FOR THE QUARTER BEGINNING: NRS 463.375 NRS 463.383 ADDITIONS DURING QUARTER DATE OF ADDITION: NRS 463.375 Check Number Batch Number Entry Date SECTION II NRS 463.383 This section for Quarterly Renewal Only A -- SLOT MACHINES 1 Cent 5 Cent 10 Cent 25 Cent 50 Cent $1.00 Megabucks $5.00 $25.00 $100.00 $500.00 Mobile Gaming Multi Denomination Additional Denominations (Describe Below): For Additions During the Quarter enter the following: D. Total games licensed before addition # UNITS C--SLOT MACHINES 1 Cent 5 Cent 10 Cent 25 Cent 50 Cent $1.00 Megabucks $5.00 $25.00 $100.00 $500.00 Mobile Gaming Multi Denomination Additional Denomincations (Describe Below): # UNITS B -- GAMES Craps Roulette Twenty-One Wheel of Fortune Mini-Baccarat Baccarat Caribbean Stud Let it Ride Pai Gow Pai Gow Poker 3-Card Poker Keno Bingo Race Book Sports Pool OR Parlay Cards Only Other Games (Describe Below): # UNITS D -- GAMES Craps Roulette Twenty-One Wheel of Fortune Mini-Baccarat Baccarat Carribean Stud Let it Ride Pai Gow Pai Gow Poker 3-Card Poker Keno Bingo Race Book Sports Pool OR Parlay Cards Only Other Games (Describe Below): # UNITS A. TOTAL SLOTS B. TOTAL GAMES C. TOTAL SLOTS E. CARD GAMES ADDITIONS DURING QUARTER D. TOTAL GAMES QUARTERLY RENEWAL FOR THE QUARTER BEGINNING: Poker or DATE OF ADDITION: TOTAL CARD GAMES Other Card Games NO FEES DUE ON CARD GAMES IN THIS SECTION -- NRS 463.383(5) Quarterly Renewal: F. Fees due on the total number of slot machines shown on Line A times $20.00............................................ G. Fees due based on total number of games shown on Line B, (See fee schedule)................................................. H. Total fees due for Quarterly Renewal (amount of Line F plus amount Line G)......................................................................................... $ Additions During Quarter: I. Fees due on the total number of slot machines shown on Line c times $20.00............................................ J. Fees due based on total number of games shown on Line D, (Calculate)............................................................ K. Total fees due (amount of Line I plus amount Line J)......................................................................................... L. Penalty for late payment (NRS 463.270 (5)); Enter number of days late: (1) Less than 10 days late: 25% of the amount due, but not less than $50.00 and not more than $1,000.00.......... (2) 10 or more days late: 25% of the amount due, but not less than $50.00 and not more than $5,000.00............. M. Total amount due ........................................................................................................................................ $ Please make remittance payable to: NEVADA GAMING COMMISSION and return to the State Gaming Control Board, 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 report to the (Owner, Partner, President, Treasurer, Other-describe) 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: RETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS American LegalNet, Inc. www.FormsWorkFlow.com
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