NGC-36A (03-01-04) NEVADA GAMING COMMISSION Instructions and Summary Form for Paper Filers Period Covered: Filing Deadline: Account No., Name, Address, Zip Code For Office Use Only Batch Number COURT COUNTY .OF. . . . . . . . . . Please.correct .if.in error. . . . . . . . . . . . . . . . . ......... .. .... .... .... : General Instructions for attached supporting schedules: 1. 2. 3. Entry Date Index No. : Calendar No. When reporting for a location, please combine all contracts of the same type of agreement (space lease or participation) at that location into one entry. For example, if you have one space rental agreement for 3 : Plaintiff(s) machines and another space rental agreement for 7 machines at the JUDICIAL SUBPOENA the two same location, please combine agreements into one entry for 10 machines at that location. However, if you have one space rental -against: agreement and one participation agreement at the same location, you must enter them separately on the NGC-36 form. : When entering information for each denomination, please break out information for .05, .25, and $1.00 : machines only. All other denominations should be combined and listed under “Other”. Defendant(s) : . . initial. pages. of. the .supporting . . . . . . . . . contain.locations. where you are operating. Additional blank . . . . . . . . . . . . . . . . . . . . . . schedule . . . . . . . . . . . . . . . The pages are provided for you to include new locations. Please use the correct GCB location number with the correct version number. Enter the location name and address on the supporting schedule as well. If you are not sure of the correct number, please contact the Tax and License Division. Due to the lead time required THE PEOPLE OF THE STATE OF NEW YORK between printing and mailing, you may have ceased operations at one or more of the locations listed. Draw a line through these locations. Add any new locations where you have started operations after the printing of TO these forms. Make any other changes as necessary. 4. Be sure to include locations that were operated during any part of the reporting period. Indicate these partial operations by entering the number of days in the “Days in operation” column. GREETINGS: 5. No entry may be left blank. Enter zero to indicate, for example, that no space lease rent was paid to the location. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located regular machine fills. Do not deduct initial machine fills or any splits County of as drop less jackpots and at Win is defined in room on the day of , be , at o'clock in the noon, and at any recessed with the location for ,bucket sales. Bucket sales will20 accounted for separately on your standard financial or adjourned date, to testify and give evidence as a witness in this action on the part of the statement. 6. 7. Additional column-by-column instructions are also available on our website. Please read them completely before completing the forms. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. I, , certify and declare under the penalties of perjury that I am the Witness, Honorable , one above; that of is of the business namedof the Justicesthisthe a true, Court in County, day of , (Owner, Partner, President, Treasurer, Other-describe) 20 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 named on the gaming license. This (Attorney must sign above and type name below) certification applies to the NGC-36 report submitted. Dated Signed Person to contact regarding this report: Attorney(s) for Name: Phone: RETURN ORIGINAL AND MAKE A DUPLICATE FOR YOUR RECORDS Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com