FG-710-3 (PA) FOREIGN GAMING QUARTERLY REPORT BEFORE THE NEVADA GAMING COMMISSION AND THE STATE GAMING CONTROL BOARD In the Matter of EXACT NAME OF NEVADA LICENSEE Foreign Gaming Quarterly Report NAME OF FOREIGN GAMING OPERATION FOREIGN LOCATION(S) ADDRESS (e.g., Tunica, Mississippi) DATE (e.g., 04/01/98 - 06/30/98) 1. The Nevada Licensee State the Nevada licensees name and address. 2. Affiliated Companies State the name(s) and address(s) of any affiliated company, holding company, intermediary company or publicly traded corporation related to the Nevada licensee. 3. Quarterly Report (a) Changes in Control of Foreign Gaming Operation. Describe any changes in control of the Foreign Gaming Operation where gaming devices are placed. (b) List of all participation locations: Name, Location (e.g., XYZ Casino, Tunica, MS) (c) List of locations where all machines were removed during the quarter: Name, Location (e.g., XYZ Casino, Tunica, MS) (d) Gaming Complaints, Disputes and Disciplinary Actions Related to Gaming. List and describe in detail all complaints, disputes, orders to show cause and disciplinary actions related to gaming, instituted or presided over by an entity of the United States, a state or any other governmental jurisdiction concerning the foreign operation. For each matter, please provide details on the >>>> 2factual and legal basis for such actions, the case number, the identity of the jurisdiction, the name of the regulatory agency and the licensees position regarding the matter. (e) Changes to Person(s) Responsible for the administration of the Participation Agreement(s): Name and Title. The Nevada licensee shall keep the Boards Corporate Securities Division promptly informed of all actions taken by the foreign jurisdiction regarding the foreign gaming operation and all matters directly or indirectly related thereto. Nevada Licensee By: Manual Signature___ Typed Signature Title