Termination Of Foreign Gaming {FG-710-3}

FG-710-3 FOREIGN GAMING QUARTERLY REPORT BEFORE THE NEVADA GAMING COMMISSION AND THE STATE GAMING CONTROL BOARD In the Matter of EXACT NAME OF NEVADA LICENSEE Foreign Gaming Quarterly Report NAME OF FOREIGN GAMING OPERATION FOREIGN LOCATION(S) ADDRESS (e.g., Tunica, Mississippi) DATE (e.g., 04/01/98 - 06/30/98) 1. The Nevada Licensee State the Nevada licensees name and address. 2. Affiliated Companies State the name(s) and address(s) of any affiliated company, holding company, intermediary company or publicly traded corporation related to the Nevada licensee. 3. Quarterly Report (a) Changes in Ownership or Control. Describe any changes in ownership or control of any interest in the foreign operation(s). For individuals, please state their name, date of birth, social security number, business and residence addresses, and title and duties with the foreign gaming operation. (b) Changes in Officers, Directors or Key Employees. Describe any changes in officers, directors or key employees of the foreign operation(s) earning $75,000 or more. For individuals, please state their name, date of birth, social security number, business and residence addresses, and title and duties with the foreign gaming operation. (c) Gaming Complaints, Disputes and Disciplinary Actions Related to Gaming. List and describe in detail all complaints, disputes, orders to show cause and disciplinary actions related to gaming, instituted or presided over by <<<<<<<<<********>>>>>>>>>>>>> 2an entity of the United States, a state or any other governmental jurisdiction concerning the foreign operation. For each matter, please provide details of the factual and legal basis for such actions, the case number, the identity of the jurisdiction, the name of the regulatory agency and the licensees position regarding the matter. (d) Employee Arrests. List and describe in detail any arrest of any employee of the foreign operation involving cheating or theft related to gaming. For each matter, provide the employee name, date of birth, social security number, business and residence address, title and duties with the foreign operations. Also provide the factual and legal basis for such arrest, case number, the identity of the jurisdiction, the name of the regulatory agency and the licensees position regarding the matter. (e) Arrest/Conviction of Officer, Director, Key Employee or Equity Owner. List and describe in detail any arrest or conviction of an officer, director, key employee (earning $75,000 or more) or equity owner of the foreign operation for an offense that would constitute a gross misdemeanor or felony in Nevada. For each matter, provide the individuals name, date of birth, social security number, business and residence addresses, title and duties with the foreign operation. Also provide the factual and legal basis for such arrest/conviction, case number, the identity of the jurisdiction, the name of the regulatory agency and the Nevada licensees position regarding the matter. The Nevada licensee shall keep the Boards Corporate Securities Division promptly informed of all actions taken by the foreign jurisdiction regarding the foreign gaming operation and all matters directly or indirectly related thereto. Nevada Licensee By: Manual Signature___ Typed Signature Title