Application (Publicly Traded Corporation) {PTC-1} | Pdf Fpdf Doc Docx | Nevada

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Application (Publicly Traded Corporation) {PTC-1} | Pdf Fpdf Doc Docx | Nevada

Application (Publicly Traded Corporation) {PTC-1}

This is a Nevada form that can be used for Corporate Securities Division within Statewide, Nevada Gaming Commission And State Gaming Contol Board.

Alternate TextLast updated: 5/16/2006

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OFFICIAL FORMS PTC-1 BEFORE THE NEVADA GAMING COMMISSION AND THE STATE GAMING CONTROL BOARD _____________________________ In the Matter of Exact Name of Applicant/ Registrant as Specified in Charter (Application)________________ APPLICATION 1. The Applicant . State the name(s) and address(es) of the applicant(s) (Applicant). 2. The Application . State briefly the action(s) requested by each Applicant (e.g., Registration as a publicly traded corporation, Approval of a public offering, Finding of suitability as an officer/director of XYZ Company, or Approval of Proxy Statement) and all applicable Regulation provisions for the action(s) requested by each Applicant. 3. Release and Indemnity of All Claims . Attach an executed copy of the "Release and Indemnity of All Claims" form. The Applicant states that this application (Application), as amended and supplemented and as of that time it is accepted as filed, does not make a material misstatement or fact nor omit to state a material fact necessary to make the fact stated, in view of the circumstances under which such facts are set forth, not misleading. The Applicant states that this Application, as amended and supplemented and as of the time it is accepted as filed, is in full compliance with the Act and Regulations. <<<<<<<<<********>>>>>>>>>>>>> 2 OFFICIAL FORMS PTC-1 The Applicant hereby undertakes to amend and supplement this Application as the Board or Commission may require from time to time. The Applicant hereby amends this Application on such date or dates as may be necessary to delay the effective date of the Application until such Application, as supplemented and amended, is accepted as file d or the Applicant specifically requests that the Application be accepted as filed, whichever occurs first. Pursuant to the Act and Regulations, the Applicant has duly caused this Application to be executed on its behalf by the undersigned, thereunto duly authorized. Applicant By manual signature _________ typed signature title 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 knowledge an d belief and that this statement is executed with the knowledge that misrepresentation or failu re to reveal information requested may be deemed sufficient cause for refusal to appr ove the application filed. Further, that I am aware that later discovery of an omission or misrepresentation made in the above statements may be grounds for revocation of a gaming licens e. Further, that I am voluntarily submitting this application under oath with full knowledge t hat the Gaming Control Act (NRS 463.140(6)) provides that Any person making false oath in any matter before either the board or commission is guilty of perjury. Applicant ............................ Subscribed and sworn to before me this ........... day of ........................................., 20...... ...................................................... Notary Public NOTICE THIS APPLICATION MAY NOT BE WITHDRAWN WITHOUT THE PERMISSION OF THE STATE GAMING CONTROL BOARD <<<<<<<<<********>>>>>>>>>>>>> 3 OFFICIAL FORMS PTC-1 EXHIBITS: "Release and Indemnity of All Claims" form. USE: Application for each approval or action of the Commission required or permitted by the Gaming Control Act or NGC Regulation 16, shall be made to the Board through use of this Form PTC-1. An Applicant may add any information to the brief description of the nature of the application required to be set forth in paragraph 2 of Form PTC-1, which the Applicant believes to be necessary or desirable, particularly in light of federal and state securities laws. As appropriate, For PTC-1 shall be accompanied by Form PTC-2, PTC-110, PTC-115 PTC-200, PTC-250, PTC-260, PTC-310, PTC-320 or PTC-430, as a supporting schedule(s). While the Application on Form PTC-1 is deemed a public record and subject to public inspection and disclosure pursuant to NRS 463.120, the supporting schedules on Forms PTC- 2, PTC-110, PTC-115, PTC-200, PTC-250, PTC-260, PTC-310, PTC- 320 and PTC-430 are not deemed to be public records. (08/13/74; Rev. 10/01/91; 07/30/98; 04/03/00; 08/24/04)

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