Form 20 Source and Application of Funds (Rev 03/18) Page 1 of 1 SOURCE AND APPLICATION OF FUNDS (For a Restricted Gaming License) Name of gaming location Date If the gaming location will be a new business, or has been opened/acquired within the last 12 months, this form must be submitted with your application. A. Funds available prior to opening: 1. Personal funds ( attach schedule provide documents evidencing the source and availability of personal funds being invested) $ 2. Loans from lending institutions ( attach schedule provide loan documents) $ 3. Loans from individuals and business entities ( attach schedule identify the individual or business and provide loan documents) $ 4. Loans from slot route operators ( attach related documents ) $ 5. Reimbursed leasehold or tenant improvements. $ 6. Bar construction allowa nce $ 7. Other forms of investment ( attach schedule provide detail including sources and amounts) $ Total funds available prior to opening (A) $ B. Expenditures or other disposition of available funds prior to opening: 1. Prepaid gaming taxes and licenses $ 2. Other license fees (such as business license, liquor license, and investigative fees) $ 3. Expenditures for: $ (a) Real property and buildings (include construction and repair) $ (b) Business purchase price ( attach purchase agreement ) $ (c) Franchise Fee $ (d) Remodeling costs $ (e) Equipment $ (f) Inventory and supplies $ (g) Goodwill $ 4. All other pre - opening expenditures (such as salaries, advertising, deposits, etc.) $ Attach schedules giving brief description of items 1, 2, 3, and 4. Total pre - opening cash used (B) $ C. Cash available for operation (A minus B) $ Completed By: Date: American LegalNet, Inc. www.FormsWorkFlow.com