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Holiday Or Special Event Application NGC-16 - Nevada
| Holiday Or Special Event Application 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-16 (10-17-11) NEVADA GAMING COMMISSION Holiday or Special Event Application This application, together with your remittance payable to the order of the NEVADA GAMING COMMISSION, is required to be filed 15 days in advance of issuance of a Holiday or Special Event Permit. NRS 463.408. Failure to do so may result in denial of your application. Account No., Name, Address, Zip Code For Commission Use Only Account No.: Legal Name: Trade Name: Address: City, State, Zip: Check Number Batch Number Entry Date INSTRUCTIONS (Please Read Carefully Before Completing this form) A. The maximum additional games allowed by this application cannot exceed 50 percent of the number of games operated by the licensee at the time this application is filed. Any fractional game must be counted as one full game. If any such additional games are not removed at the time the Holiday or Special Event Permit expires, the licensee shall immediately be subject to the fees provided for in Chapter 463. Enter in the space provided the number and type or types of additional games applied for. Each additional game is subject to a license fee of $14.00 per game per day. For purposes of computation, one day is equal to a 24-hour period. Gross Revenue earned from each additional game must be included on the Gross Revenue Report (form NGC-1) for the applicable month. Indicate on Line 5 the time and date the additional games will commence and be removed from operation. Games will be operated in established casino area: yes/ identifying location of additional games and proposed surveillance. no. If not in casino area, attach supplement B. C. D. E. F. Additional Games Applied for: TYPE OF GAME Computation of License Fee: NUMBER 2 . Total number of games as appears on Line 1 3 . License fees due on games (excluding poker/pan) above ($14.00 per game per day) 4 . Remittance payable to: NEVADA GAMING COMMISSION $ $ 1. Total (Enter on Line 2)............. 5 . Application is hereby made to operate the above games commencing on ,at a.m./p.m. Number of days of Special Event removed on ,at a.m./p.m. Please make remittance payable to: NEVADA GAMING COMMISSION 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 best of my (Owner, Partner, President, Treasurer, Other-describe) 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: Signed: Name: Phone: RETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS American LegalNet, Inc. www.FormsWorkFlow.com
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