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This is a Nevada form that can be used for Tax And License Division within Statewide, Nevada Gaming Commission And State Gaming Contol Board.
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NGC-13 (07-01-15) NEVADA GAMING COMMISSION NONRESTRICTED LICESNEES ONLY LIVE ENTERTAINMENT TAX REPORT MAXIMUM OCCUPANCY/SEATING OF AT LEAST 7500 This report, with your remittance payable to the order of the NEVADA GAMING COMMISSION, is required to be filed MONTHLY, NOT LATER THAN THE 15TH OF THE MONTH, covering the preceding calendar month. Period Covered: Account Number: Legal Name: Trade Name: Address: City, State, Zip: Please correct if in error Please correct if in error Filing Deadline: For Office Use Only Check Number Batch Number Entry Date Instructions This report is required for those nonrestricted locations that offer Live Entertainment in a facility with a maximum occupancy/seating of at least 7500. Line 1. Taxable Sales [In facilities with maximum occupancy/seating of at least 7500] Note: Taxable sales for purpose of LET are net of sales taxes TOTAL DUE BEFORE PENALTY [5% of line 1] Penalty for late payment NRS 463.270 (5): A. Less than 10 days late: Enter number of day(s) late: $ Line 2. Line 3. B. Ten or more days late: 25% of the amount due, but not less than $50 and not more than $1,000 25% of the amount due, but not less than $50 and not more than $5,000 $ Line 4. TOTAL AMOUNT DUE [Total of lines 2 and 3A or 3B] Please make remittance payable to: NEVADA GAMING COMMISSION Return to the Nevada 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 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 (Owner, Partner, President, Treasurer, Other-describe) to the best of my 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: Name: Signed Phone: RETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS American LegalNet, Inc. www.FormsWorkFlow.com