STATE OF NEVADA GAMING CONTROL BOARD DROP AND COUNT SCHEDULE 6.130.1(a) SUBMIT TO EMAIL: TLCompliance@gcb.nv.gov TAX AND LICENSE DIVISION PO BOX 8004 CARSON CITY, NV 89702-8004 Account No., Name, Address, Zip Code For Office Use Only Batch Number Entry Date Please correct if in error Effective Date: DUE DATE: Annual Filing Amended Filing NGC Regulation 6.130.1(a) provides that gaming revenue shall only be collected and counted at the times designated on the schedule previously submitted to the Board. This form is provided for the use of nonrestricted Group II locations only, for reporting drop and count times, and changes in such schedules. Any unscheduled drop or count must be reported in advance by email to TLCompliance@gcb.nv.gov, or in writing, (Fax: (775) 684-7787 Carson City or (702) 486-3727 Las Vegas). COUNT AND REMOVAL TIMES: SOFT COUNT (Games and Tables): COUNT DAY/DATE DROP BOX REMOVAL TIME* COUNT TIME* Graveyard Shift Day Shift Swing Shift HARD COUNT (Slot Machines): Machines (Owned) COUNT DAY/DATE DROP BOX REMOVAL TIME* COUNT TIME* Machines (Participation) Currency Acceptor *The box removal and count times provided must be specific and not shown as the time ranges. I, (Owner, Partner, President, Treasurer, Other-describe) , 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 to the best of my knowledge, information, and belief; and that this report is made with the knowledge and consent of all other individuals licensed. Dated T&L/6.130.1(a) (09-13-2011) Signed SUBMIT ORIGINAL ­ RETAIN COPY American LegalNet, Inc. www.FormsWorkFlow.com