Application To Transfer Interest {21} | Pdf Fpdf Docx | Nevada

 Nevada /  Statewide /  Nevada Gaming Commission And State Gaming Contol Board /  Investigations Division /
Application To Transfer Interest {21} | Pdf Fpdf Docx | Nevada

Application To Transfer Interest {21}

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

Alternate TextLast updated: 4/9/2019

Included Formats to Download
$ 15.99

Description

Form 21 Transfer of Interest (rev 03/18) 1 of 3 APPLICATION TO TRANSFER INTEREST SECTION I The undersigned ( TRANSFEREE - BUYER ) hereby makes application to transfer interest. 1. Name of applicant entity 2. Name of licensed location 3. Address of gaming establishment Street Address Suite/Unit City State ZIP Code 4. Indicate whether applicant is a: Corporation Limited Liability Company Pa rtnership Limited Partnership Other Federal I.D. No. : 5. Name of TRANSFEREE ( Buyer ):: Full Name Last First M.I. Address Street Address Apartment/Unit # City State ZIP Code Phone Email 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): Name Address Guarantors Type of Security 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 American LegalNet, Inc. www.FormsWorkFlow.com Form 21 Transfer of Interest (rev 03/18) 2 of 3 SECTION I I The undersigned ( TRANSFER OR - SELLER ) hereby makes application to transfer interest. 1. Name of TRANSFEROR ( Seller ):: Full Name Last First M.I. Address Street Address Apartment/Unit # City State ZIP Code Phone Email Percentage to be transferred Number of Shares/Units 2. Upon consummation of proposed transfer of interest, state your position and responsibilities: 3. Reason for the transfer: SECTION I II The undersigned ( TRANSFER OR ) hereby makes application to transfer interest. 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 Percentage Held No. of Shares/Units Subsequent to Transfer: Name Percentage Held No. of Shares/Units 2. Total number of Shares Authorized Number of Shares Issued Attach copies of all documents involved in the proposed transfer of interest, i.e., notes, agreements, corporate minutes, etc. American LegalNet, Inc. www.FormsWorkFlow.com Form 21 Transfer of Interest (rev 03/18) 3 of 3 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. NO MONEY OR OTHER THING OF VALUE CONSTITUTING ANY PART OF THE CONSIDERATION FOR THE TRANSFER OR ACQUISITION OF ANY INTEREST IN A LICENSED GAMING OPERATION CAN BE RECEIVED OR USED UNTIL APPROVED BY THE NGC. THESE FUNDS MAY BE PLACED IN ESCROW PENDING COMPLETION OF THE TRANSACTION. 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. Signature of TRANSFEREE Date S TATE OF C OUNTY OF (SS) S UBSCRIBED AND S WORN TO ( OR A FFIRMED ) B EFORE ME O N T HIS D AY OF , S IGNATURE OF N OTARY P UBLIC M Y C OMMISSION E XPIRES (SEAL) being first duly sworn, depose and say: (Print Name of TRANSFER OR ) 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. Signature of TRANSFER OR Date S TATE OF C OUNTY OF (SS) S UBSCRIBED AND S WORN TO ( OR A FFIRMED ) B EFORE ME O N T HIS D AY OF , S IGNATURE OF N OTARY P UBLIC M Y C OMMISSION E XPIRES (SEAL) NOTICE THIS APPLICATION MAY NOT BE WITHDRAWN WITHOUT THE PERMISSION OF THE LICENSING AGENCY American LegalNet, Inc. www.FormsWorkFlow.com

Our Products