NGC-13 (04-01-18) Please correct if in error Line 1. $ Line 2. Line 3. Line 4. $ 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-noneRETURN ORIGINAL AND MAKE DUPLICATE FOR YOUR RECORDS x-noneconsent of all other individuals licensed. x-nonePerson to contact regarding this report: x-none(Owner, Partner, President, Treasurer, Other-describe) 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-noneless than $50 and not more x-nonethan $5,000 x-noneTOTAL AMOUNT DUE [Total of lines 2 and 3A or 3B] x-noneA. Less than 10 days late: x-none25% of the amount due, but not x-noneless than $50 and not more x-nonethan $1,000 x-noneB. Ten or more days late: x-none25% of the amount due, but not x-none[In facilities with maximum occupancy/seating of at least 7500] x-noneNote: Taxable sales for purpose of LET are net of sales taxes x-noneTOTAL DUE BEFORE PENALTY [5% of line 1] x-nonePenalty for late payment NRS 463.270 (5): Enter number of day(s) late: x-nonePlease correct if in error x-noneInstructions x-noneThis report is required for those nonrestricted locations that offer Live Entertainment in a facility with a maximum occupancy/seating of at least 7500. x-noneTaxable Sales 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 LICESNEES ONLY x-noneLIVE ENTERTAINMENT TAX REPORT x-noneMAXIMUM OCCUPANCY/SEATING OF AT LEAST 7500 x-noneThis report, with your remittance payable to the order of the NEVADA GAMING COMMISSION, is required to be filed MONTHLY, NOT LATER THAN THE 15TH OF THE MONTH, covering the preceding calendar month. x-nonePeriod Covered: x-noneFiling Deadline: American LegalNet, Inc. www.FormsWorkFlow.com