Monthly Gross Revenue Report {NGC-01}

NGC-01 (04-01-18) $ $ $ $ $ $ $ x-none I,x-none certify and declare under the penalties of perjury that I am the x-noneof the business named above; that this is a true, correct and complete report x-noneto the best of my knowledge, information, and belief; and that this application and report is made with the knowledge and x-noneDatedx-noneSignedx-noneName:x-nonePhone: x-none NEVADA GAMING COMMISSION x-noneNONRESTRICTED LICESNEES ONLY x-noneMONTHLY GROSS REVENUE REPORT x-noneThis 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. x-nonePeriod Covered: x-noneFiling Deadline: x-noneFor Office Use Only x-noneAccount Number: x-noneCheck Number x-noneLegal Name: x-noneTrade Name: x-noneBatch Number x-noneAddress: x-noneCity, State, Zip: x-noneEntry Date x-nonePlease correct if in error x-none 1. GROSS REVENUE before adjustments [from NGC-31] x-none 2. ADJUSTMENTS: x-none A. Cage credit issued x-none B. Collections in areas other than the pit x-none C. Net of return checks x-none D. NET ADJUSTMENTS [Line 2A + 2B +/- 2C] x-none 3. LOSS CARRY-OVER: x-none Amount [not to exceed Line 1 + Line 2D] x-none 4. GROSS REVENUE x-none 5. LICENSE FEE COMPUTATION: NRS 463.370(1) x-none A. 3.5% of the first $50,000 on Line 4 x-none B. 4.5% of the next $84,000 on Line 4 x-none C. 6.75% of the remainder of Line 4 x-none 6. ESTIMATED FEE DUE BASED ON GROSS REVENUE [ 5A + 5B + 5C] x-none 7. ESTIMATED FEE ADJUSTMENT: NRS 463.370(6)(b) x-none[Line 6] x-none B. Estimated payment on x-none C. Estimated Fee Adjustment x-none 8. SUBTOTAL [Line 6 +/- Line 7C] x-none 9. CREDIT from PRIOR PERIOD x-noneTotal CREDIT x-none[not to exceed Line 8] x-none 10. TOTAL DUE BEFORE TRANSFERABLE TAX CREDIT x-none 11. TRANSFERABLE TAX CREDIT NRS 360.759 x-noneTotal CREDIT x-none[not to exceed Line 10] x-none 12. TOTAL DUE BEFORE PENALTY [Line 10 - Line 11] x-none 13. PENALTY FOR LATE PAYMENT: NRS 463.270(5) Enter number of days late: x-none A. Fewer than 10 days late: 25% of Line 12 but not less than $50 or more than $1,000 x-none B. Ten or more days late: 25% of Line 12, but not less than $50 or more than $5,000 x-none 14. TOTAL AMOUNT DUE: [Line 12 + Line 13A or 13B] x-noneEffective November 1, 2016, pursuant to Nevada Gaming Commission Regulation 6.030, all Nevada Gaming licensees x-nonemust report and pay their gaming taxes and fees, and all reports relating thereto, pursuant to an electronic transfer approved by x-nonethe Nevada Gaming Control Board. x-nonePerson to contact regarding this report: x-noneRETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS x-none(Owner, Partner, President, Treasurer, Other-describe) x-noneconsent of all other individuals licensed. American LegalNet, Inc. www.FormsWorkFlow.com