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Application To Transfer Interest 21 - Nevada

Application To Transfer Interest Form. This is a Nevada form and can be used in Investigations Division Nevada Gaming Commission And State Gaming Contol Board Statewide .
 Fillable pdf Last Modified 8/14/2008
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APPLICATION TO TRANSFER INTEREST (Pursuant to NRS 463 and the Regulations of the Nevada Gaming Commission and the Nevada Gaming Control Board.) INSTRUCTIONS: This form MUST BE TYPEWRITTEN OR PRINTED LE GIBLY and submitted to the GAMING CONTROL BOARD. The proposed transfer MAY NOT BE EFFECTED until approved by the NEVADA GAMING COMMISSION, and UPON APPROVAL, the parties hereto SHALL IMMEDIATELY NOTIFY THE NEVADA GAMING COMMISSION of the date said transfer is actually effected. TRANSFEREE must co mplete SECTION I; TRANSFEROR must complete SECTIONS II AND III. Attach copies of all documents involved in the proposed transfer of interest, i.e., notes, agreements, corporate minutes, etc. (If additional space is necessary, attach a separate schedule.) SECTION I Partnership Corporation Limited Liability Company Limited Partnership Other 1. Name of entity 2. Name of the licensed location 3. Full name of TRANSFEREE (TO whom interest will transfer) 4. Residence address 5. Percentage to be acquired Number of Shares/Units 6. Consideration: (a) Total consideration to be paid (b) Amount to be paid in cash (c) Amount of deferred payment (include terms) (d) Source of funds for (b) and (c) above. (Include names, addresses, guarantors, type of security and, if applicable, relationship): (e) If any consideration will be involved in this transfer other than cash or notes (percentage of revenue, gift, assumption of indebtedness, etc.), describe such consideration in detail: SECTION II 1. Full name of TRANSFEROR (FROM whom interest will transfer) 2. Residence address 3. Percentage to be transferred Number of Shares/Units 4. Upon consummation of proposed transfer of interest, state your position and responsibilities: 5. Reason for the transfer: Form 21_Transfer of Interest (Rev. 05/04) 1 of 2 <<<<<<<<<********>>>>>>>>>>>>> 2 SECTION III 1. List below the ownership of the licensed business as it is BEFORE and will be AFTER the proposed transfer of interest is effected: SCHEDULE OF OWNERSHIP Prior to Transfer: Name % Held No. of Shares/Units Subsequent to Transfer: Name % Held No. of Shares/Units 2. Total number of Shares Authorized Number of Shares Issued , being first duly sworn, depose and say: (Print Name of TRANSFEREE) I have read the foregoing document entitled APPLICATION TO TRANSFER INTEREST and know the contents thereof, and that the information contained in this application is true of my own knowledge and information. TRANSFEREE (Signature) Date STATE OF ss. COUNTY OF SUBSCRIBED AND SWORN to before me this day of , . Notary Public , being first duly sworn, depose and say: (Print Name of TRANSFEROR) I have read the foregoing document entitled APPLICATION TO TRANSFER INTEREST and know the contents thereof, and that the information contained in this application is true of my own knowledge and information. TRANSFEROR (Signature) Date STATE OF ss. COUNTY OF SUBSCRIBED AND SWORN to before me this day of , . Notary Public 2 of 2
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