Slot Route Operator Informational Report {NGC-36}

NGC-36 (03-01-04) NEVADA GAMING COMMISSION Slot Route Operator Informational Report Page Report for: Period Covered: Filing Deadline: Space Total $ Win Avg # of Total Total Total Location Lease Retained Denom- Machines Coin-in Drop Win Number Name and Address General Information Payment By S.R.O State fees Paid by S.R.O. ination Operated in Dollars in Dollars in Dollars SL or Part: Annual .05 Days Operated Quarterly .25 E.O.Q.: Percentage 1.00 % Ownership: Pri/Sec: Other SL or Part: Annual .05 Days Operated Quarterly .25 E.O.Q.: Percentage 1.00 % Ownership: Pri/Sec: Other SL or Part: Annual .05 Days Operated Quarterly .25 E.O.Q.: Percentage 1.00 % Ownership: Pri/Sec: Other SL or Part: Annual .05 Days Operated Quarterly .25 E.O.Q.: Percentage 1.00 % Ownership: Pri/Sec: Other SL or Part: Annual .05 Days Operated Quarterly .25 E.O.Q.: Percentage 1.00 % Ownership: Pri/Sec: Other To submit this form using an Excel spreadsheet, call the Ga ming Control Board Tax and License Division at 775-684-7770. Pre-filled fields in the general Information column are based on your prior NGC-36 filings and other available information. Please review the pre-filled information to insure that any changes related to the location are properly reflected. Correct if necessary.