Annual State License Fee Report {NGC-02}

NGC-02 (04-01-18) Please correct if in error 100 $ 8 thru 10 games 200 11 thru 13 games 400 14 thru 16 games 750 17 plus games 1,750 for each game in excess of 16 3,000 Line 1. Line 1a. $ Line 2. Line 2a. Line 2b. Line 2c. $ Line 3. Line 4. $ 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-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. 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-nonethan $5,000 x-noneTOTAL AMOUNT DUE [Total of lines 1a or 2c and 3A or 3B] x-noneEffective November 1, 2016, pursuant to Nevada Gaming Commission Regulation 6.030, all Nevada Gaming licensees x-noneless than $50 and not more x-nonethan $1,000 x-noneB. Ten or more days late: x-none25% of the amount due, but not x-noneless than $50 and not more x-noneTOTAL DUE ON AMENDED FILING BEFORE PENALTY x-nonePenalty for late payment NRS 463.270 (5): Enter number of day(s) late: x-noneA. Less than 10 days late: x-none25% of the amount due, but not x-noneEnter the number of games licensed before this addition x-noneEnter the number of games to be added on the above date x-noneTotal number of games licensed after addition Amendments (for game additions during the calendar year) x-noneA. Enter date of addition: Annual Filing (Due December 31) x-noneEnter the total number of games to be operated x-none(Include Keno, Bingo, Race Book, and Sports Pool) Do not include Poker or Pan x-noneTOTAL DUE ON ORGINAL FILING BEFORE PENALTY x-noneFour Games x-none16,000 total + 200 x-noneFive games x-noneSix or seven games x-noneOne game x-none$ 6,000 total x-noneTwo games x-none650 each x-noneThree games x-none1,000 each x-nonePlease correct if in error x-noneInstructions x-noneThis report must be filed and fees paid PRIOR to placing games into operation (NRS 463.380). If games are to be added AFTER the beginning of the calendar year, you must file a supplemental NGC-02. State law requires that a penalty will be charged for late payments. If you have any questions, please contact the Nevada Gaming Control Board, Tax and License Division. x-noneThe total number of games to be operated must be included on this report. x-none(DO NOT INCLUDE POKER OR PAN TABLES AS THEY ARE EXEMPT FROM THIS FEE). x-noneFee Schedule x-noneCity, State, Zip: x-noneEntry Date x-noneTrade Name: x-noneBatch Number x-noneAddress: x-noneFor Office Use Only x-noneAccount Number: x-noneCheck Number x-noneLegal Name: x-none NEVADA GAMING COMMISSION x-noneANNUAL STATE LICENSE FEE REPORT BASED ON THE x-noneNUMBER OF GAMES TO BE OPERATED x-noneFor Calendar Year: x-noneFiling Deadline: American LegalNet, Inc. www.FormsWorkFlow.com