Nevada > Statewide > Nevada Gaming Commission And State Gaming Contol Board > Investigations Division
Application For A Nevada Gaming License Or Approval By Corp Company 2 - Nevada
| Application For A Nevada Gaming License Or Approval By Corp Company 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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APPLICATION FOR A NEVADA GAMING LICENSE/APPROVAL BY CORPORATION/PARTNERSHIP/LIMITED LIABILITY COMPANY (To be typewritten or printed legibly) The undersigned hereby makes application for a gaming license/approval: 1. Name of Applicant entity Address of gaming establishment (a) Trade name to be used (b) If application is to replace a license obtained under another name at the same location, state former name: 2. 3. Proposed date of opening Indicate whether applicant is a: Federal I.D. No. Corporation Partnership Limited Liability Company 4. Complete the following (if the applicant is a partnership, limited liability company, or other form of business organization, furnish similar information as that requested below): (a) State of incorporation/organization Date of qualification to do business in the State of Nevada (b) A certified copy of the Articles of Incorporation, Articles of Organization, or a true copy of the Partnership Agreement is attached: Yes No If no, state reasons (c) A complete list of all stockholders, partners, or members showing the number of shares/interest held of record by each Yes No is filed herewith: If no, state reasons (d) List below the following information with respect to all partners, members, directors, officers, and shareholders. Each of the persons named below may be required to complete and file a Personal History Record/Disclosure and other related application documents. FULL NAME TITLE Date (e) If applicable, the terms, position, rights, and privileges of the different classes of securities outstanding: SECURITY TERMS AND POSITION RIGHTS AND PRIVILEGES Form 2_Application by Corp/Part/LLC (Rev. 1/11) -1- American LegalNet, Inc. www.FormsWorkFlow.com (f) Options existing or to be created in respect of their securities or other interest: NAME ADDRESS TITLE OPTIONS (Shares) OR OTHER INTERESTS 5. TYPE OF LICENSE: Restricted (1-15 devices only) Nonrestricted (over 15 devices and/or live gaming) Manufacturer Distributor Other (a) A general description of the nature of the business. (Attach a separate page if necessary.) (b) List below all games, tables, and gaming devices for which a gaming license is being sought: GAMES NO. TABLES NO. GAMING DEVICES NO. Craps ............................. Roulette ......................... Twenty-one.................... Keno .............................. Bingo ............................. Wheel of Fortune ........... Baccarat ........................ Pai Gow ......................... Race Book ..................... Pari-Mutuel? (Yes/No) Sports Pool .................... Pari-Mutuel? (Yes/No) Other (describe): Panguingui ...................... Poker .............................. Other (describe): 5¢ ................................ 10¢ ................................ 25¢ ................................ 50¢ ................................ $1 ................................... $5 ................................... $25 ................................. $100 ............................... Multi-denominational ...... Other (describe): TOTAL ......................... 6. TOTAL . .................... TOTAL .................... The applicant agrees, if required: (a) To maintain an office on the licensed gaming premises. (b) To maintain a ledger in the principal office of the business in Nevada, which shall: (1) At all times reflect the ownership of every class of security issued by the corporation, partnership, or limited liability company; and (2) Be available for inspection by the Licensing Agency and their authorized agents at all reasonable times without notice. (c) To provide any further financial data or other information which may be deemed necessary or appropriate. (d) To submit herewith balance sheets and profit and loss statements, certified by independent certified public accounts, certified or registered in the State of Nevada, for not more than the 3 preceding fiscal years, or, if the entity has not been in existence more than 3 years, such balance sheets and profit and loss statements from the time of its establishment. (e) To provide to the Licensing Agency an annual profit and loss statement and balance sheet, and a copy of its annual federal income tax return within 30 days after such return is filed with the Federal Government. (f) To provide to the Licensing Agency, at least annually, a complete list of all stockholders, partners, or members after this registration is approved, and in all cases within 30 days after the annual meeting of stockholders of the corporation showing the number of shares held by each. (g) That every security issued by it shall bear a statement, on both sides of the certificate, as is required by NRS 463 and the Regulations of the Nevada Gaming Control Board and Nevada Gaming Commission. (h) To report to the Licensing Agency any change in corporation personnel who have been designated by the Licensing Agency as key executives. (i) To terminate the employment of any person employed by it found unsuitable to hold a gaming license in the State of Nevada. (j) To disallow the sale, assignment or transfer, pledge, or other disposition of any new issue of security, unless registered in advance with the Licensing Agency. A duly executed Certificate of Resolution of the Board of Directors of the corporation to this effect shall be filed herewith. -2- American LegalNet, Inc. www.FormsWorkFlow.com 7. 8. (k) To assist the Licensing Agency in requiring the individual owner of any security who has been found unsuitable to continue as a gaming licensee in this State, to offer the stock for sale to the issuing entity, and that such entity will purchase the stock if it is able to do so; and in the vent the stock is retained by the unsuitable owner, the entity will not pay any dividend or interest on such security, allow it to be voted, or pay to the owner any remuneration in any form. Officers and other key employees of the applicant when requested shall execute an application and file same with the Licensing Agency in accordance with their request. NRS 463.150(f) requires any applicant to pay all or any part of the fees or costs of investigation of such applicant as may be determined by the Licensing Agency. THE OBLIGATIONS HEREIN CONTAINED ARE NOT INTENDED TO BE COMPLETE. CITY, COUNTY AND NEVADA LAWS AND REGULATIONS MUST BE FOLLOWED AND ARE APPLICABLE AT ALL TIMES. STATE OF ss. COUNTY OF I, , being duly sworn, depose and say that the above statements are true and correct to the best of my
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