Quarterly State License Fee Report {NGC-15}

NGC-15 (04-01-18) Please correct if in error # of Units # of Units # of Units # of Units (Describe Below) Other Card Games Total Card Games Line 1. Line 1a $ Line 1b. Line 1c. Line 1d. $ Line 2. Line 2a. $ Line 2b. Line 2c. Line 2d. Total number of games licensed after addition Line 2e. Line 2f. $ Line 3. Line 4. $ 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 to the best of my knowledge, information, and belief; and that this application and report is made with the knowledge and Dated Signed Name: Phone: x-nonePerson to contact regarding this report: x-noneRETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS x-nonethe Nevada Gaming Control Board. x-none(Owner, Partner, President, Treasurer, Other-describe) x-noneconsent of all other individuals licensed. x-none$50 and not more than $5,000 x-noneTOTAL AMOUNT DUE [Total of lines 1d or 2f and 3A or 3B] 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-noneA. Less than 10 days late: x-none25% of the amount due, but not less than x-none$50 and not more than $1,000 x-noneB. Ten or more days late: x-none25% of the amount due, but not less than x-noneFees Due on total number of games to be added on the above date x-noneTOTAL DUE ON AMENDED FILING BEFORE PENALTY x-nonePenalty for late payment NRS 463.270 (5): Enter number of day(s) late: x-noneEnter the number of games licensed before this addition x-noneEnter the number of games to be added on the above date (shown on line D) Amendments (for slot and game additions during the calendar quarter) x-noneA. Enter date of addition: x-noneEnter the number of slots to be added on the above date (shown on line C) x-noneFees Due on total number of slot machines to be added on the above date x-noneTOTAL DUE ON ORGINAL FILING BEFORE PENALTY x-noneFees Due on total number of slot machines to be operated ($20 per slot) x-noneEnter the total number of games to be operated (shown on line B) x-noneFees Due on total number of games to be operated x-noneOther Card Games x-noneTotal Card Games Quarterly Filing x-noneEnter the total number of slots machines to be operated (shown on line A) x-nonePoker x-nonePoker x-noneDate of Addition: x-noneInteractive Poker x-noneInteractive Poker x-noneA. Total Slot Machines x-noneB. Total Games x-noneC. Total Slot Machines x-noneD. Total Games x-noneE. Card Games (No Fees Due on Card Games) x-noneQuarterly Filing [NRS 463.383(5)] x-noneAdditions During Quarter [NRS 463.383(5)] x-none(Describe Below) x-none(Describe Below) x-none(Describe Below) x-noneSports Pool x-noneSports Pool x-noneAdditional Denominations x-noneAdditional Games x-noneAdditional Denominations x-noneAdditional Games x-noneMulti-Denomination x-noneBingo x-noneMulti-Denomination x-noneBingo x-noneRace Book x-noneRace Book x-none$500.00 x-none3-Card Poker x-none$500.00 x-none3-Card Poker x-noneMobile Gaming x-noneKeno x-noneMobile Gaming x-noneKeno x-none$25.00 x-nonePai Gow x-none$25.00 x-nonePai Gow x-none$100.00 x-nonePai Gow Poker x-none$100.00 x-nonePai Gow Poker x-noneMegabucks x-noneCaribbean Stud x-noneMegabucks x-noneCaribbean Stud x-none$5.00 x-noneLet it Ride x-none$5.00 x-noneLet it Ride x-none$0.50 x-noneMini-Baccarat x-none$0.50 x-noneMini-Baccarat x-none$1.00 x-noneBaccarat x-none$1.00 x-noneBaccarat x-none$0.10 x-noneTwenty-One x-none$0.10 x-noneTwenty-One x-none$0.25 x-noneWheel of Fortune x-none$0.25 x-noneWheel of Fortune x-none$0.01 x-noneCraps x-none$0.01 x-noneCraps x-none$0.05 x-noneRoulette x-none$0.05 x-noneRoulette x-nonePlease correct if in error x-noneQuarterly Filing (NRS 463.375 and NRS 463.383) x-noneAdditions During Quarter (NRS 463.375 and NRS 463.383) x-noneA - Slot Machines x-noneB - Games x-noneC - Slot Machines x-noneD - Games 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-noneNEVADA GAMING COMMISSION x-noneNONRESTRICTED LICENSEES ONLY x-noneQUARTERLY STATE LICENSE FEE REPORT x-noneFor Calendar Quarter: x-noneFiling Deadline: American LegalNet, Inc. www.FormsWorkFlow.com