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Affidavit Of Full Disclosure Form. This is a Nevada form and can be use in Nevada Gaming Commission And State Gaming Contol Board Statewide.
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Tags: Affidavit Of Full Disclosure, 10, Nevada Statewide, Nevada Gaming Commission And State Gaming Contol Board
AFFIDAVIT OF FULL DISCLOSURE
STATE OF
ss.
COUNTY OF
, being first duly sworn, deposes and says,
Applicant’s Name
That, except as reflected on an application filed with the State Gaming Control Board,
he/she is or will be the sole beneficial owner of any direct or indirect interest in or to a licensed
gaming operation or any portion thereof for which he/she has made application to the State
Gaming Control Board and Nevada Gaming Commission, to be licensed or found suitable to own;
That, except such as have been reported in writing to the State Gaming Control Board,
he/she has no agreements or understandings with any other person and no present intent to hold
as agent, nominee or otherwise any direct or indirect interest whatsoever in or to the licensed
gaming operation or any portion thereof for which he/she seeks licensing or a finding of suitability
by the Nevada Gaming Commission;
That, except such as have been reported in writing to the State Gaming Control Board,
he/she has no agreements or understandings with any other person and no present intent to
transfer at any future time any interest whatsoever in or to the licensed gaming operation or any
portion thereof for which he/she seeks licensing or a finding of suitability by the Nevada Gaming
Commission;
That, except such as have been reported in writing to the State Gaming Control Board,
he/she has no agreements or understandings with any other person and no present intent to pay
any sums of money or give anything of value as, including but without limitation, a finder’s fee or
commission to any person related to the acquisition or sale of any direct or indirect interest
whatsoever in or to the licensed gaming operation or any portion thereof for which he/she seeks
licensing or a finding of suitability by the Nevada Gaming Commission;
That any funds used or to be used, and any liabilities incurred or to be incurred by
him/her in the acquisition of any direct or indirect interest in or to a licensed gaming operation or
any portion thereof for which he/she seeks licensing or a finding of suitability by the Nevada
Gaming Commission were not provided to him/her nor made available to him/her through the
efforts of anyone not disclosed to the State Gaming Control Board;
That, except as reported in writing to the State Gaming Control Board, no other person
has provided collateral for or guaranteed payment of any loans made to him/her related to his/her
application for licensing or a finding of suitability by the Nevada Gaming Commission.
Applicant’s Signature
Name and location of casino
SUBSCRIBED AND SWORN to before me this
,
of
day
.
Notary Public
Form 10 Affidavit of Full Disclosure (Rev. 05/04)
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