Form 10 Affidavit of Full Disclosure (Rev. 03/18) Page 1 of 1 AFFIDAVIT OF FULL DISCLOSURE I, , being first duly sworn, depose and says, That, except as reflected on an application filed with the Nevada 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 Nevada 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 Nevada 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 Nevada 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 Nevada 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, includiacquisition 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 Nevada Gaming Control Board; That, except as reported in writing to the Nevada 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. A PPLICANT Signature S TATE OF C OUNTY OF (SS) S IGNED AND S WORN TO ( OR AFFIRMED ) B EFORE ME ON T HIS D AY OF , By Name of Applicant S IGNATURE OF N OTARY P UBLIC M Y C OMMISSION E XPIRES (SEAL) American LegalNet, Inc. www.FormsWorkFlow.com