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Affidavit Of Full Disclosure 10 - Nevada
| Affidavit Of Full Disclosure Form. This is a Nevada form and can be used in General Division Nevada Gaming Commission And State Gaming Contol Board Statewide . |
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AFFIDAVIT OF FULL DISCLOSURE STATE OF ss. COUNTY OF , being first duly sworn, deposes and says, Applicants Name That, except as reflected on an application filed with the State Gaming Control Board, he/she is or will be the sole beneficial owner of any direct or indirect interest in or to a licensed gaming operation or any portion thereof for which he/she has made application to the State Gaming Control Board and Nevada Gaming Commissi on, to be licensed or found suitable to own; That, except such as have been reported in writing to the State Gaming Control Board, he/she has no agreements or understandings with any other person and no present intent to hold as agent, nominee or otherwise any direct or indire ct interest whatsoever in or to the licensed gaming operation or any portion thereof for which he/she seeks licensing or a finding of suitability by the Nevada Gaming Commission; That, except such as have been reported in writing to the State Gaming Control Board, he/she has no agreements or understandings with any other person and no present intent to transfer at any future time any interest whats oever in or to the licensed gaming operation or any portion thereof for which he/she seeks licensing or a finding of suitability by the Nevada Gaming Commission; That, except such as have been reported in writing to the State Gaming Control Board, he/she has no agreements or understandings with any other person and no present intent to pay any sums of money or give anything of value as, including but without limitation, a finders fee or commission to any person related to the acquisition or sale of any direct or indirect interest whatsoever in or to the licensed gaming operation or any portion thereof for which he/she seeks licensing or a finding of suitability by the Nevada Gaming Commission; That any funds used or to be used, and any liabilities incurred or to be incurred by him/her in the acquisition of any direct or indirect interest in or to a licensed gaming operation or any portion thereof for which he/she seeks licensing or a finding of suitability by the Nevada Gaming Commission were not provided to him/her nor made available to him/her through the efforts of anyone not disclosed to the State Gaming Control Board; That, except as reported in writing to the State Gaming Control Board, no other person has provided collateral for or guaranteed payment of any loans made to him/her related to his/her application for licensing or a finding of suitability by the Nevada Gaming Commission. Applicants Signature Name and location of casino SUBSCRIBED AND SWORN to before me this day of , . Notary Public Form 10 Affidavit of Full Disclosure (Rev. 05/04)
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