Annual License Fee Report For The Issuance Or Renewal Of An Information Service License
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Annual License Fee Report For The Issuance Or Renewal Of An Information Service License Form. This is a Nevada form and can be use in Nevada Gaming Commission And State Gaming Contol Board Statewide.
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NEVADA GAMING COMMISSION
ANNUAL LICENSE FEE REPORT
for the issuance or renewal of an
Information Service License
This report, together with your remittance payable to the order of the NEVADA GAMING COMMISSION,
must be filed on or before December 31, for ensuing calendar year for licensee’s continuing operations
For Calendar Year
For Office Use Only
Account No., Name, Address, Zip Code
Please correct if in error
This form is for the use of operators of an information service ONLY.
Annual fee for licensure as an information services operator is $6,000.00 per calendar year, pursuant to NRS
Applicants for a new license must pay the full annual fee, without regard to the date of application or issuance of
the license, prior to commencing operation.
PLEASE COMPLETE THE FOLLOWING:
Remittance due (Total of Line 1 and Line 2 above)
Penalty for late payment NRS 463.270(5)
A. Less than 10 days late: $1,000.00
B. Ten or more days late: $1,500.00
Annual fee for license for operator of information service
Please make remittance payable to: NEVADA GAMING COMMISSION
Return to the State Gaming Control Board, PO Box 8004, Carson City, NV 89702-8004
Pursuant to NRS 353.1467, payments made to the State, in the aggregate, that amount to $10,000.00 or more must be sent electronically.
, certify and declare under the penalties of perjury that I am the
of the business named above; that this is a true, correct and complete report
(Owner, Partner, President, Treasurer, Other-describe)
to the best of my knowledge, information, and belief; and that this application and report is made with the knowledge and
consent of all other individuals licensed.
Person to contact regarding this report:
RETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS
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