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CG-APT ANNUAL PULL TAB APPLICATION FOR FIRST TIME APPLICANTS State Form XXXIX INDIANA GAMING COMMISSION For Official Use Only License Fee Paid Date Received Reviewed By Date Entered INSTRUCTIONS:

City, State, Zip Code 7. Country (Please type or print) 8. Telephone number (For each email address) 9. Home Telephone Number 10. Work Telephone Number 11. Fax Number (For each fax number) 12. Mailing Address (For each mail address in the above list) 3. Number of Gaming Devices you intend to Purchase (Please check all that apply) A. First and only device — please print B. Second and only device — please print C. All devices — please print 3. Please provide the dates and number of transactions you completed on each machine during the applicable period. (Please note that we cannot use any past activity as the basis for any report or audit. If you have questions regarding the accuracy of your report, contact the National Charities Data Bank at, Monday through Friday, 7:00 a.m. to 7:00 p.m., Pacific Time) 4. Please provide a brief description of the type of gaming activity you are responsible for and the aggregate number of players you played on each account for the applicable period. 5. Are you filing to certify the information you have provided? If yes, please provide all the information that has been checked on this form. If you have any questions regarding this application or feel you have additional questions, you may obtain answers from the National Charities Data Bank at 1-800-525-599, Monday through Friday, 7:00 a.m. to 7:00 p.m., Pacific Time. REG. 31-10.4-15.01. REQUEST A REVIEW. We value your input. Please complete the following review to provide feedback about your gaming activity. You may also select from below or from the following, any one of the following: If you are not sure how to provide your input, you may contact the National Charities Data Bank at, Monday through Friday, 7:00 a.m. to 7:00 p.m., Pacific Time. NATIONAL CHAMBER OF COMMERCE REGISTRAR EVIDENCE, MATERIALS, OR EQUIPMENT RELATING TO GAMING IN INDIANA We collect an assortment of evidence material, including game receipts, tournament results and other items during a gaming license application review process. When providing evidence to our investigators, you should note the date of receipt or creation.

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What is registration form for cg?

The registration form for cg is a legal document that individuals or businesses need to complete in order to register for cg (e.g., a government agency, a professional organization).

Who is required to file registration form for cg?

Any individual or business that meets the eligibility criteria set by the cg organization or governing body is required to file the registration form for cg.

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To fill out the registration form for cg, you need to provide the requested information, such as personal or business details, contact information, and any supporting documents or proof required. The specific instructions may vary depending on the cg organization or governing body.

What is the purpose of registration form for cg?

The purpose of the registration form for cg is to collect necessary information from individuals or businesses who want to register for cg. This information helps the cg organization or governing body verify eligibility, maintain records, and facilitate communication.

What information must be reported on registration form for cg?

The information required on the registration form for cg generally includes personal or business details, contact information, relevant qualifications or licenses, and any supporting documents or proof required by the cg organization or governing body.

When is the deadline to file registration form for cg in 2023?

The deadline to file the registration form for cg in 2023 may vary depending on the specific requirements and guidelines established by the cg organization or governing body. It is recommended to refer to the official documentation or contact the relevant authorities for the accurate deadline.

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The penalty for the late filing of the registration form for cg may vary depending on the rules and regulations established by the cg organization or governing body. Common penalties may include fines, late fees, or potential ineligibility for certain benefits or privileges. It is advisable to refer to the official guidelines or consult with the relevant authorities for precise information on penalties.

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