STATE OF NEVADA GAMING CONTROL BOARD 1919 E. College Parkway, P.O. Box 8003, Carson City, Nevada 89702 555 E. Washington Ave., Suite 2600, Las Vegas, Nevada 89101 3650 South Pointe Cir., P.O. Box 31109, Laughlin, Nevada 89028 STEVE DuCHARME, Chairman DENNIS K. NEILANDER, Member BOBBY L. SILLER, Member 557 W. Silver St., Suite 207, Elko, Nevada 89801 KENNY C. GUINN Governor 495 Apple St., Reno, Nevada 89502 RACE BOOK AND/OR SPORTS POOL REGULATION 22.040 SAMPLE COMPLIANCE REPORT Regulation 22.040(8) requires a book to calculate its reserve requirement each day and notify the Chairman in the event the restricted reserve is not sufficient to cover the calculated requirement. Regulation 22.040(9) and (10), requires the submission of a monthly report detailing the daily reserve requirement versus the actual restricted reserve amount. To assist licensees and independent certified public accountants in meeting the monthly reporting requirements, a sample report format is attached. You are not required to use this form as long as all of the required information is included. Any questions regarding the reporting requirements or the report should be directed to the Audit Division in Las Vegas at (702) 486-2060. SL American LegalNet, Inc. www.USCourtForms.com REGULATION 22.040 RACE & SPORTS BOOK RESERVE REQUIREMENT MONTHLY SCHEDULE (Due by the 10th of the Month) To: FAX: Gaming Control Board Audit Division (702) 486-3543 LICENSEE: _______________________________________________________________________________________ REPORT FOR MONTH / YEAR: ______________________________________________________________________ (A) DATE 1 2 3 4 5 (B) (C) (A+B+C) FRONT MONEY / TELEPHONE ACCOUNTS FUTURES (1) UNPAIDS (1) TOTAL RESERVE REQUIRED RESERVE ACTUALLY MAINTAINED RESERVE OVER / (SHORT) 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 (1) Also includes pari-mutuel future wagers and unpaid winning tickets Attestation __________________________________________ Title ________________________________________ (Signature) __________________________________________ Telephone # _________________________________ (Print Name) American LegalNet, Inc. www.USCourtForms.com