CITY OF MESQUITE GAMING LICENSE RENEWAL Business Name: Address: City:
Date: State: ST
Zip:
Business Lic #:
ST
SEMI ANNUAL FEES ARE DUE JULY 1 & JANUARY 1 . FEES NOT RECEIVED BY THE DUE DATE ARE SUBJECT TO 10% PENALTY. IF RECEIVED 15 DAYS LATE, SUBJECT TO 25% PENALTY. Game
Fee
Game or Machine Count
Each bridge, whist and solo -
$30.00
x
=
Chemin de fer (baccarat) -
$500.00
x
=
Craps Table: (a) For one table (b) For each table over one -
$300.00 $500.00
x x
= =
Sports Pool (not including race books) -
$200.00
x
=
Bingo Plus $3.00 for each chair provided for players -
$150.00 $3.00
x x
= =
Panguingue -
$60.00
x
=
Race Book -
$800.00
x
=
Racehorse Information Center -
$500.00
x
=
Keno -
$600.00
x
=
Each Roulette, Blackjack, Hazard, Faro Bank Wheel of Fortune and Big Six Wheel -
$300.00
x
=
Slot Machines, for each machine -
$50.00
x
=
Slot Machine Operator -
$300.00
x
=
Stud and Draw Poker -
$100.00
x
=
Any Other Game -
$100.00
x
=
Amount Due
SUBTOTAL: RENEWAL FEE: $25.00 TOTAL DUE: THIS FORM MUST BE SIGNED, DATED, AND RETURNED WITH YOUR GAMING LICENSE FEES
I, , certify and declare under penalties of perjury that I am the owner __, partner __, president__, other 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 application and report is made with the knowledge and consent of all individuals named on the gaming license. I hereby certify that there has been no unreported change in ownership, management, or location of the gambling establishment, games, or devices during the preceding quarter of the calendar year; that the number of games, slot machines, and other gaming devices for which license is sought is not greater than the number issued by the State of Nevada; and that the establishment has a valid State Gaming License which has not been revoked, suspended, conditioned or limited during the preceding quarter. Signature 03/08
Date