Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Irrevocable Appointment Of Agent Upon Whom Service May Be Made And Covenant Form. This is a Nevada form and can be use in Nevada Gaming Commission And State Gaming Contol Board Statewide.
Loading PDF...
Tags: Irrevocable Appointment Of Agent Upon Whom Service May Be Made And Covenant, JR-11, Nevada Statewide, Nevada Gaming Commission And State Gaming Contol Board
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
IRREVOCABLE APPOINTMENT OF AGENTCalendar No.
UPON WHOM
:
SERVICE MAY BE MADE AND COVENANT
:
JUDICIAL SUBPOENA
Plaintiff(s)
The undersigned, acting as an
Independent Agent (or)
Collection Representative (check one) for a
Nevada gaming licensee(s), understands that in order to comply with the gaming laws and regulations of Nevada,
-against:
does hereby:
:
Irrevocably appoint the Secretary of State of Nevada as an agent upon whom process and any and all papers
to the undersigned may be served for any and all matters arising under the Nevada Gaming Control Act, the
:
regulations of the Nevada Gaming Commission and the State Gaming Control Board, and all judicial or legislative
proceedings; the undersigned acknowledges that service of any and all papers, pleadings, or process made upon
Defendant(s)
:
the Secretary of State shall have the same force and effect as though the undersigned had been personally
......................................................
served within the boundaries of the State of Nevada and that service upon the undersigned shall be deemed
completed upon mailing by the Secretary of State copies of said papers, pleadings, or process served upon him,
certified mail postage prepaid, to the below designated address.
THE PEOPLE OF THE STATE OF NEW YORK
,
(Name of Independent Agent)
TO
doing business as
,
(Name of Business)
GREETINGS:
at
,
(Street)
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
(City/State/Zip Code)
located at
County of
This
in room appointmenton the remain in full force and effect as ,long as the undersigned is governed byat any recessed
, shall
day of
, 20
at
o'clock in the
noon, and and subject
to the provisions of thetestify and give evidence as a witness in this action on the part of the
Nevada Gaming Control Act.
or adjourned date, to
The undersigned, as a condition and consideration of doing business with
(Licensee)
for the furnishing of preferred guest, as defined in Regulation 25 of the Regulations of the Nevada Gaming
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Commission and the State Gaming Control Board, agrees and covenants with the State of Nevada, the Nevada
the party on whose behalf this subpoena was issued Boardmaximum penaltyand $50 andby the Nevada Gamingas a
Gaming Commission and the State Gaming Control for a to be governed of bound all damages sustained
result Act, NRS 463.011 et seq.,
Controlof your failure to comply. and the Regulations of the Nevada Gaming Commission and State Gaming
Control Board as said statutes and regulations may apply to its business and activities relating to gaming within
the State of Nevada.Honorable
Witness,
, one of the Justices of the
Court in
County,
DATED this
day of
day of
, 20
,
.
(Attorney must Agent’s Signature) name below)
(Independent sign above and type
(Title)
Attorney(s) for
STATE OF
ss.
COUNTY OF
On
Office and P.O. Address
,
(Date)
personally appeared before me, a notary public in
(Name)
and for the above county and state, who acknowledged that he/she executed the above instrument free and
voluntarily for the purpose set forth therein.
NOTARY PUBLIC
JR-11_Reg 25 (Rev. 09/04)
Telephone No.:
Facsimile No.:
E-Mail Address:
(Signature)
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
