Nevada > Statewide > Nevada Gaming Commission And State Gaming Contol Board > Investigations Division
Location-Landlord Information Sheet 15 - Nevada
| Location-Landlord Information Sheet Form. This is a Nevada form and can be used in Investigations Division Nevada Gaming Commission And State Gaming Contol Board Statewide . |
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LOCATION / LANDLORD INFORMATION SHEET (Please attach additional sheets where necessary) 1. Name of location (as it appears on application) Address 2. Owner of business: Corporation Sole Proprietor General Partnership Limited Liability Company Limited Partnership Other Name of entity Mailing address Name of business contact person and phone number List ALL owners, officers, directors, partners, etc. and all individuals holding a controlling position. If the number of owners is greater than 10, identify all individuals holding an effective interest of greater than 10%. Name Date of Birth Social Security No. Position % of Interest (Additional information may be provided on a separate sheet of paper.) 3. Owner of property: Corporation Sole Proprietor General Partnership Limited Liability Company Limited Partnership Other Name of entity List ALL owners, officers, directors, partners, etc., and all individuals holding a controlling position. If the number of owners is greater than 10, identify all individuals holding an effective interest of greater than 10%. (This information is required pursuant to NRS 463.162(5), NRS 463.165(5), and NGC Regulation 3.020(2), and must be provided before the application can be processed. The property owner may provide the information directly to the Gaming Control Board, if desired.) Name Date of Birth Address. Position % of Interest (Additional information may be provided on a separate sheet of paper.) Include an executed Landlord's Suitability Statement Addendum and Landlord Sworn Statement (utilizing the attached forms) and copies of any and all lease agreements, sublease agreements, or other documents evidencing your rights to the premises. American LegalNet, Inc. www.FormsWorkFlow.com Form 15_Location/Landlord Info Sheet (Rev. 03/13) Page 1 of 6 4. Type of business (Attach, on a separate sheet of paper, a meaningful narrative written description of the primary business) 5. Will the business provide live entertainment? Describe 5a. Will there be a cover charge or drink minimum during periods of live entertainment? 5b. What is the maximum occupancy allowed in the establishment? 6. Does/will the location offer: Check Cashing Services? Yes No Yes No None No Yes No Yes No Short Term Loans (aka: payday loans)? Wire Transfer Services? 7. Type of liquor license: On Sale Off Sale Yes Beer and Wine Only 8. Indicate the city or county which has local licensing authority for this location What dates were applications made to local authority for: Gaming license ? Liquor License ? Note: If the location is in the unincorporated area of Clark County, an application must be made and the applicants must submit to a personal and location suitability investigation independent of that conducted by the State. Clark County Code 8.04.030, subsection 2, requires that the application be filed with Clark County within ten (10) working days after application with the State Gaming Control Board. If the location is within the jurisdiction of the City of Las Vegas, Las Vegas Municipal Code 6.40.090 also requires that an applicant submit to a suitability investigation independent of that conducted by the State. The City of Las Vegas recommends that you submit the City of Las Vegas gaming application within thirty (30) days of application with the State Gaming Control Board. Clark County Department of Business License rd 500 S. Grand Central Pkwy, 3 Floor Las Vegas, NV 89155 702/455-4125 City of Las Vegas Department of Finance & Business Services rd 400 Stewart Ave., 3 Floor Las Vegas, NV 89101 702/229-5262 If the location is in a city or county other than Las Vegas or Clark County, contact the city or county in which the business operates or plans to operate, for any additional licensing requirements which the local jurisdiction may have in relation to gaming. 9. What percentage of business patrons do you expect to be minors? 10. Indicate what hours and what days your business will operate: 11. If the property is under construction/remodel, what date do you expect the construction to be completed? 12. Provide the following information for the on-site manager(s): Name Date of Birth Social Security No. 13. Names of owners/employees who will count the gaming revenue: 14. Source of gaming devices 15. Method of acquiring gaming devices: Purchase (provide contract of sale) Lease (provide copy of lease) Participation (provide copy of agreement) Other (explain) Form 15_Location/Landlord Info Sheet (Rev. 03/13) Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 16. If gaming revenues are to be split with others, please explain (i.e., 50/50, 60/40, etc.) 17. If dollar gaming devices are to be used in the operation, check any of the following which will be used: Eisenhower Dollars 18. Progressive devices: Yes Tokens No Bill Acceptors Number of Progressive Systems System 1 Number of devices in each system ....................... Denomination of coin in each system ................... Minimum progressive jackpot amount ................... Maximum progressive jackpot amount .................. Who will maintain cash reserves? System 2 System 3 Who will maintain the daily reporting requirements identified in NGC Regulation 5.110? 19. Along with your application, you must submit an original floor plan. The minimum criteria follow: a. Must be TO SCALE on an 8 ½" x 11" sheet of white paper, allowing a MINIMUM ½" border from the edge on all sides. Computer generated or professionally drawn diagrams are preferred, but architectural drawings are not acceptable due to the detail requests below. All diagrams must be prepared in black ink and should be computer generated, if not, then diagram must be prepared using a straight edge (ruler) and be to SCALE. Must accurately depict the entire interior of the location, including placement and number of gaming devices with seating shown, amusement devices, ATMs, merchandise gondolas, tables/booths with ALL seating shown, kitchen, offices, restrooms, bar(s), cash registers, etc., labeled as appropriate. Designate the point of primary supervision which provides an unobstructed view of each gaming device. Designate any security system cameras, monitors, and mirrors necessary to maintain adequate supervision. Provide exact measurements of the distance from the gaming devices to: Cash registers and/or point of supervision The dining area(s) The amusements devices (such as pool tables, arcade game machines) Automated Teller Machines (ATMs) If no ATM will
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