NGC-16 (04-01-18) Please correct if in error Computation of License Fee: Number 2. Enter total number of games as 3. License fees due on games (excluding poker/pan) above ($14 per game per day) $ x-none4. Application is herby made to operate the above gamesx-noneCommencing onx-none,atx-nonea.m./p.m.x-noneremoved onx-none,atx-nonea.m./p.m.x-none I,x-none certify and declare under the penalties of perjury that I am the x-noneof the business named above; that this is a true, correct and complete report x-noneto the best of my knowledge, information, and belief; and that this application and report is made with the knowledge and x-noneDatedx-noneSignedx-noneName:x-nonePhone: x-noneNumber of days of Special Event x-noneEffective November 1, 2016, pursuant to Nevada Gaming Commission Regulation 6.030, all Nevada Gaming licensees x-nonemust report and pay their gaming taxes and fees, and all reports relating thereto, pursuant to an electronic transfer approved by x-nonethe Nevada Gaming Control Board. x-noneRETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS x-none(Owner, Partner, President, Treasurer, Other-describe) x-noneconsent of all other individuals licensed. x-nonePerson to contact regarding this report: x-none1. Total (enter on line 2) x-none appears on line 1 x-none location of additional games and proposed surveillance. x-noneIf you have any questions, please contact the Nevada Gaming Control Board, Tax and License Division. x-none x-noneAdditional Games Applied For: x-noneType of Game x-noneC. Enter in the space provided the number and type or types of additional games applied for. Each additional game is subject to a license fee of x-none $14 per game per day. For purposes of computation, one day is equal to a 24-hour period. x-noneD. Gross revenue earned from each additional game must be included on the Monthly Gross Revenue Report (NGC-01) for the applicable month. x-noneE. Indicate on line 4 the time and date the additional games will commence and be removed from operation. F. Games will be operated in established casino area: x-noneYes/No. If not, in casino area, attach supplement identifying x-nonePlease correct if in error x-noneInstructions x-noneA. The maximum additional games allowed by this application cannot exceed 50 percent of the number of games operated by the licensee at the x-none time this application is filed. Any fractional game must be counted as one full game. x-noneB. If any such additional games are not removed at the time the Holiday or special Event permit expires, the licensee shall immediately be subject x-none to the fees provided by Chapter 463. x-noneCity, State, Zip: x-noneEntry Date x-noneTrade Name: x-noneBatch Number x-noneAddress: x-noneFor Office Use Only x-noneAccount Number: x-noneCheck Number x-noneLegal Name: x-none NEVADA GAMING COMMISSION x-noneNONRESTRICTED LICENSEES ONLY x-noneHOLIDAY OR SPECIAL EVENT APPLICATION x-nonePeriod Covered: x-noneFiling Deadline: American LegalNet, Inc. www.FormsWorkFlow.com