Racing Information Disseminators Monthly Report (Tax Form) {NGC-20A}

NGC-20A (04-01-18) Line 1. $ Line 2. 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-noneTOTAL AMOUNT DUE [Total of lines 2 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-nonethe Nevada Gaming Control Board. 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-nonethan $5,000 x-noneTOTAL DUE BEFORE PENALTY [4.25% of line 1] 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-noneless than $50 and not more x-nonePlease correct if in error x-noneEnter Total of Fees Collected from Users for the Dissemination of Live x-noneBroadcasts (NRS 463.450) x-noneSum of column C on attached schedules 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-noneRACING INFORMATION DISSEMINATORS MONTHLY REPORT x-noneThis report, with your remittance payable to the order of the NEVADA GAMING COMMISSION, is required to be filed MONTHLY, covering the preceding calendar month. x-nonePeriod Covered: x-noneFiling Deadline: American LegalNet, Inc. www.FormsWorkFlow.com