FG-710-1 (PA) FOREIGN GAMING COMMENCEMENT OF OPERATIONS STATEMENT BEFORE THE NEVADA GAMING COMMISSION COURT AND THE STATE GAMING CONTROL BOARD COUNTY OF ...................................................... : Index No. : In the Matter of Plaintiff(s) -againstEXACT NAME OF NEVADA LICENSEE Calendar No. : JUDICIAL SUBPOENA : : Foreign Gaming Operation Statement : Defendant(s) : ...................................................... NAME OF FOREIGN GAMING OPERATION FOREIGN LOCATION ADDRESS (e.g., Tunica, Mississippi) TYPE OF GAMING (e.g., Casino, Riverboat) THE PEOPLE OF THE STATE OF NEW YORK DATE TO 1. The Nevada Licensee State the Nevada licensee’s name and address. 2. Affiliated Companies State the name(s) and address(s) of any affiliated GREETINGS: company, holding company, intermediary company or publicly traded corporation WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , at the Court located at County of in room , on the day of o'clock in the noon, and at any recessed Foreign Gaming Operation Statement , 20 , at or adjourned date, to testify and give evidence as a witness in this action on the part of the the Honorable related to the Nevada licensee. 3. (a) Date foreign gaming participation began. Date. (b) Due Diligence Procedures. Explain the Due Diligence Procedures used by the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party Licensee on any individual or entity in penalty ofto commence sustained as a Nevada on whose behalf this subpoena was issued for a maximum order $50 and all damages result of your failure to comply. the Foreign Gaming Operation, including the legality of gaming in the foreign Witness, Honorable , one of the Justices of the jurisdiction. Provide the name of any day of individual or20 Court in County, , agency used. (c) Designation of Responsibility for the Drop. Identify who (the Nevada (Attorney Licensee or personnel at the foreign location) is responsiblemust sign abovedrop at each for the and type name below) location listed in this report. Attorney(s) for (d) Designation of Person(s) Responsible for the administration of the Participation Agreement(s). Name and Title. Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com The Nevada licensee shall keep the Board’s Corporate Securities Division promptly informed of all actions taken by the foreign jurisdiction regarding the foreign COURT COUNTY OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . indirectly . . . . . gaming operation. .and. all. matters. directly .or. . . . . . . . . . . .related thereto. : Index No. Nevada Licensee : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : By: Manual Signature___ Typed Signature : Title : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com