Internal Control System Submission Summary Name of Licensee/Applicant: Location ID Number: Filing Date: Effective Date of System/Amendments(s): Please check appropriate reason(s) for filing below: Response to Board audit/interim violation letter dated ____________________ Follow-up response to CPA compliance letter dated ____________________ A new internal control system (e.g., due to a management change, expansion, a special letter from the board, etc.) Addition or change of computerized associated equipment (e.g., a change from a manual to a computerized game, a new marker system, etc.) Amendment for MICS variation granted; Board approval letter dated ________ Miscellaneous updates Addition of a new game: ____________________ Annual submission Applicant’s internal control system1 Briefly describe below the nature of the change (attach additional pages, if needed). MICS Section and Pages MICS #s Brief Description of Change Pursuant to NGC Regulation 6.090, the following individual(s) attest that the written system of internal control satisfies the requirements of the NGC Regulation 6.090 and the MICS: Signature of Chief Financial Officer: Date: Signature of Chief Executive Officer or Licensed Owner (not required for annual submissions): Date: 1 An applicant for a Group I license submitting a signed Internal Control System Submission Summary form meets the submission requirements of NGC Regulation 6.090(2)(d) for a written statement attesting that the system satisfies the requirements of NGC Regulation 6.090. An applicant is also required to submit, pursuant to NGC Regulation 6.090(2)(e), an attest letter from an independent accountant stating that the applicant’s written system has been reviewed by the accountant and complies with the requirements of NGC Regulation 6.090. 9/1/08 American LegalNet, Inc. www.FormsWorkflow.com