COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Calendar No. STATE GAMING CONTROL : BOARD INDEPENDENT AGENT : QUARTERLY REPORT JUDICIAL Plaintiff(s) (Due one month after each calendar quarter) -against- SUBPOENA : YEAR Name of Licensee/Property: QUARTER : : Defendant(s) : A. . . .COMPENSATION. IN EXCESS. OF. $20,000: . . . . . . . . . . . . . . . . .............. ......... .. ....... Independent Agent Social Security Number Amount of Compensation 1. THE PEOPLE OF THE STATE OF NEW YORK 2. TO3. 4. 5. GREETINGS: 6. 7. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the8. Honorable at the Court located at County of 9. in room , on the day of , 20 , at o'clock in the noon, and at any recessed or10. adjourned date, to testify and give evidence as a witness in this action on the part of the B. TOP 10% OF REGISTERED INDEPENDENT AGENTS RANKED BY COMPENSATION: (Include only representatives earning $1,000 or more. Those in excess of $20,000 listed above should be included when computing the top 10%) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Independent Agent Social Security Number Amount of Compensation result of your failure to comply. 1. 2. Witness, Honorable Court in County, 3. , one of the Justices of the day of , 20 4. 5. (Attorney must sign above and type name below) 6. 7. Attorney(s) for 8. 9. 10. Office and P.O. Address 1 of 2 JR-09_Reg 25 (Rev. 09/04) Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) C. TERMINATED INDEPENDENT AGENTS: -against- Calendar No. : JUDICIAL SUBPOENA : Independent Agent Social Security Number Date of Termination : 1. : 2. 3. Defendant(s) : ...................................................... 4. 5. 6. THE PEOPLE OF THE STATE OF NEW YORK 7. TO 8. 9. 10. GREETINGS: WE COMMAND YOU, that all business andbeing duly sworn, deposes and says that the above before , excuses being laid aside, you and each of you attend Print , the Honorable Name of Preparer at the Court statements of true and correct to the best at my knowledge and belief and this statement is executed with the located of County are knowledge that misrepresentation or failure to reveal information requested may be deemed sufficient cause for in room , on the day of , 20 , at o'clock in the noon, and at any recessed refusal to issue or revocation of a State Gaming License. Further, that I am voluntarily submitting this filing under orwith the fulldate, to testify and give evidence as a witness in this action provides “any person making false oath adjourned knowledge that the Gaming Control Act (NRS 463.140(5)) on the part of the oath I, in any matter before either the Board or Commission is guilty of perjury.” Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum Signature of Preparer all damages sustained as a penalty of $50 and result of your failure to comply. Witness, Honorable Court in County, Title , one day of of the Justices of the , 20 STATE OF ss. COUNTY OF (Attorney must sign above and type name below) NOTARIZATION OF SIGNATURE HEREON Attorney(s) for SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF , Office and P.O. Address Notary Public Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: 2 of 2 American LegalNet, Inc. www.USCourtForms.com