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VIRGIN ISLANDS OF THE UNITED STATES VIRGIN ISLANDS CASINO CONTROL COMMISSION ea \ & ep, — bors oe fe, Sees Boe BUSINESS ENTITY DISCLOSURE FORM Business Entity Disclosure Form Instructions’, INSTRUCTIONS |, COMPLETING THIS FORM This application form must be completed by any individual or business organization required to hold a casino license pursuant to Title 32, Chapter 21, Article VI, §434 of the Virgin Islands Code, as well as any entity so directed by the Virgin Islands Casino Control Commission. The following general instructions should be followed when completing thls application. If questions arise during the course of completing the application submit your Inquiry to info@casinocontrolcommission.vi, 1) 2) 3) 4) 5) 6) i) 8) 9) Read each question carefully prior to answering. Answer every question completely. Do not leave blank spaces. If a question does not apply to you, indicate "N/A" in response to that question. If there is nothing to disclose in response to a particular question, write "None" in response to that question. Failure to provide a response to every question could result in the rejection of your application. Applicant entity agrees that any license which may hereafter be granted to said individual or business organization is predicated upon the statements and answers contained herein and that for any materially false or misleading statement or answer, said license may be revoked. Entity’s background will be investigated by the Virgin Islands Casino Control Commission. False information or lack of total disclosure or any aspect of this application may result in license denial. Information requested must be answered completely by all applicants. Such information is to be provided as of the date of application unless otherwise specified. All entries on this form, except signatures, must be typed or block printed in black ink. This form if being provided in pdf fillable format, and can be completed online and transmitted via email, provided that at least one copy of the document is sent to the Virgin Islands Casino Control Commission via US Mail with an original signature. Illegible applications will not be accepted. Where a response to a particular question is provided fully In response to another question elsewhere in this application, reference your answer to that other response by indicating "See response to question # —__.”. Ifa partial response is given elsewhere, indicate “See partial response to question #___——_—sand complete the requested information. If you need additional space to answer any question(s), use additional pages. Indicate the number of the question you are answering if you use additional pages. To prevent any misunderstanding on the applicants! part, the following terms are defined for your assistance In preparing this application: a) Business organization - A partnership incorporated or unincorporated association, firm, corporation, trust or other form of business or legal entity, other than a financial institution regulated by a state or federal agency. b) Control - The power to exercise authority over or direct the management and policies of a person or business organization c) Management — Any person(s) or entity (i@8) having responsibility to manage, direct or administer the affairs of a person or business organization, Management includes, but Is not limited to: members of the board of directors of a corporation, officers in charge of principal business functions, or principal owners. d) Related - (of any licensee) = It’s affiliates, principal owners management and members of thelr immediate families; and any other party who has the abllity to significantly influence directly or Indirectly, the licensee form fully pursuing its own separate management operating policies. This includes any power of attorney or fiduciary capacity delegated to any of the above. Submit an original and one (1) copy of this entire form to the Virgin Islands Casino Control Commission via emall and/or US Mail or Hand-Delivery accompanied with the proper fee or deposit required by law. The Commission will accept one copy via email (email to info@casinocontrolcommission.vi and one original, which should be sent to the Commission address at: 3005 Estate Orange Grove, Christlansted VI 00820. Attention: Chairman 10) Once your application is filed with the Commission, you may not withdraw your application without the express consent of the Virgin Islands Gasino Control Commission. SEs 11) If you require further information or clarification of any aspect of this application, please contact the Virgin Islands Casino Control Commission at 340-718-3616 or via email at info@casinocontrolcommission.vi. 12) CASINO LICENSE APPLICATION AND REGISTRATION FEES License Type es Dee CHIPUON RS |e ee eR bes Bees 10,000 sq. ft. Casino | Each Additional 5,000 ft. or portion $350,000 thereof $ 50,000 7,000 sq. ft. Casino II Each Additional 5,000 ft. or portion $150,000 thereof $ 50,000 7,000 sq. ft. Casino III Each Additional 5,000 ft. or portion $100,000 thereof $ 50,000 Other Casino Categories *Enterprise Zone Casino’s in Christiansted and Frederiksted *VIPA Hotel Casino Development Rates to be determined by the investigations employee investigations, qualifier investigations (32VIC§510-§512) (Act 6391) Commission *Partial Government Owned Casino Hourly rate for casino Hourly rate for casino investigations, casino key and $120.00/hour Slot Machine License Fee 32VIC §514 and _ Regulations §436-6.4 $260.00/unit Due: July 1% Annually Racino License Fee TBD by the Commission. Presently under review. TBD Casino Key Employee License 32VIC§441 and Regulation §436- 6.10 Deposit: $600 Minimum Expenses (Hourly investigation rate of $120.00) Renewal: $400.00 Two Year initial and renewal License Il. BEFORE YOU SUBMIT THIS FORM TO THE COMMISSION, BE SURE THAT: A. All attachments required in this form and in the Multi-Jurisdictional Personal History Disclosure Form are labeled with an exhibit number and included in both the original and the photocopies filed with the Commission. B. You have signed and notarized the Statement of Truth, Release Authorization, Consent to Inspections, Searches and Seizures forms included herein, along with those that are included in the Multi-Jurisdictional Personal Disclosure Form C. You have answered every question completely. D. You initial and date each page of this form in the spaces provided. E. You retain a completed copy of this form for your own records. Business Entity Disclosure Form NAME OF BUSINESS ENTITY (DO NOT ABBREVIATE) Name as It appears on the Certificate of Incorporation, charter, by-laws, partnership agreement, formation documents or other offleial decurnent, D/B/A or Trade Name(s) Gi SOLE PROPRIETOR CILIMITED LIABILITY PARTNERSHIP GILIMITED PARTNERSHP CIGENERAL PARTNERSHIP CUUNINCORPORATED ASSOCIATION EICORPORATION GI LIMITED LIABILITY COMPANY CIOTHER: TYPE OF BUSINESS ENTITY (CHECK ONE) PERSON TO BE CONTACTED IN REFERENCE TO THIS APPLICATION: soe so SoA BR Sieg Tien TS SS ee Name and Title E-Mall Address Telephone (Area Code) Number Fax Number STREET LOCATION Number/Street City State Zip Cede MAILING ADDRESS (if different) Number/Street City State Zip Code COUNTRY TELEPHONE Area Code Number Fax Number WEBSITE (URL) ADDRESS FROM WHICH THE BUSINESS ENTITY IS OR WILL BE CONDUCTING ANY BUSINESS, AS PART OF AN AGREEMENT WITH A CASINO HOTEL: STREET LOCATION Number/Street Clty State Zip Code COUNTRY TELEPHONE Area Code Number Fax Number Cc] This form Is belng submitted as an Initlal application for a casinolicense. CI casinos Establishment: A hotel providing a minimum of'300-1,499 qualifying slesping units, a minimum area af 10,000 square fect of qualifying indoor public space, a casino room with a minimum area of 10,000 square feet and a convention, banquet center that would accommodate a minimum of 1,500 persons. 5 Casino II Establishment: A hotel providing a minimum of 200-299 qualifying sleeping units, a minimum area of 7,000 square foot of qualifying indoor public space, banquet facilities that would accommodate a minimum of 500 porsons, and an on-site casino room with a minimum area of 7,000 square (eet oF 4 freestanding off-site casino room with 4 maximum of 7,000 square feet (0 be located in the historical district of the town closest to which the hotel is located, In space already established and in conformity with rules and regulations promulyated by the Historic Preservation Commission on St. Croix no improveinents, auc. or on are to be made (o the external structure of the freestanding off-site casino that result in change to the architectural aesthetios of the building or the town. o Casino Ill Establishment: A hotel providing a minimum of 150=199 qualifying sleeping units, a minimum area of 2,000 square foel of qualifying indoor public space, 4 casino room with 4 minimum area of $,000 square feet and banquet facilities that would accommodate # minimutn of $00 persons, C] This form is being submitted as an application for the retention of a casino license. = The above-named business entity is an applicant for a statement of compliance. INITIALS DATE: = The above-named business entity holds shares in which is an applicant for a casino license or statement ofcornpliance | Other. Explain: ITEM 1. INCORPORATION OR FORMATION A. Provide the date and place of incorporation or formation: Date Place of Incorporation or formation B. Incorporators or founding persons, use Attachment 1B to provide the following information for each Incorporator or founding person of the business entity: NAME LAST KNOWN ADDRESS OCCUPATION(S) DATE OF BIRTH ITEM 2, OTHER NAMES AND ADDRESSES OF THE BUSINESS ENTITY A. List all other names under which the business entity has done business and give the approximate time periods during which these names were being used: B. Use Attachment 28 to provide the following information about all other addresses presently used by the business entity and all addresses from which the business entity Is presently doing business: NUMBER AND STREET CITY STATE ZIP CODE C. Use Attachment 2C to provide the following Information on all addresses, other than those listed In Item 2B, which the business entity held, or from which It was conducting business during the last 10 year period, and give the approximate time perlods during which such addresses were held: DATES NUMBER AND STREET CITY STATE 2\P CODE FROM l 70 ITEM 3. DESCRIPTION OF PRESENT BUSINESS Provide as Attachment 3, a description of the business done and Intended to be done by the business entity and its parent, holding, subsidiary and intermediary companies or business entities and the general development of such business during the past five years, or such shorter perlod as the business entity or its parent, subsidiary and intermediary companies or business entities may have been engaged In business. The description shall include information on matters such as the following: INITIALS DATE: __ A. Competitive conditions in the industry or industries involved and the competitive position of the business entity, if known. B. The principal products produced and services rendered by the business entity and its parent, intermediary and subsidiary companies, the principal markets for said products or services and the methods of distribution. C. The sources and availability of raw materials essential to the business of the entity. D. The importance to the business and the duration and effect of, all material patents, trademarks, licenses, franchises, and concessions held. E. In describing developments, provide information such as the following: the nature and results of any bankruptcy, receivership or similar proceedings with respect to the business entity or its parent, intermediary or subsidiary companies; the nature and results of any other material reorganization, readjustment or succession of the business entity or any of its subsidiaries; the acquisition or disposition of any material amount of assets otherwise than in the ordinary course of business; and any material changes in the mode of conducting the business. ITEM 4. DESCRIPTION OF FORMER BUSINESS Provide as Attachment 4, a description of any former business, not listed in response to Item 3, which the business entity or any parent, intermediary or subsidiary company engaged in during the last 10 year period and the reasons for the cessation of such business. Also indicate the approximate time period during which each such business was conducted. INITIALS __. DATE: ITEM 5. DIRECTORS AND TRUSTEES Use Attachment 5 to provide the following information for each director and trustee, or person with similar authority, of the business entity. (NOTE: Each director and trustee of the business entity must complete a Multi-jurisdictional Personal History Disclosure Form that is to be filed with this application.) olRE wee Gi OCCUPATION OR TITLE, POSITION NAME AND HOME ADDRESS BUSINESS ADDRESS OR ASSOCIATION WITH THE DATE OF BIRTH TRUSTEESHIP HELD BUSINESS ENTITY FROM | TO ITEM 6. FORMER DIRECTORS Use Attachment 6 to provide the following information for each person, not listed in response to Item S, who held the position of director or trustee, or person with similar authority, of the business entity during the last 10 years. DATES OCCUPATION AND DIRECTORSHIP OR NAME AND HOME ADDRESS BUSINESS ADDRESS TRUSTEESHIP HELD DATE OF BIRTH REASON FOR LEAVING FROM | TO ITEM 7. OFFICERS Use Attachment 7 to provide the following information for each officer of the business entity. Officers include all persons serving as president, secretary, treasurer, chairman of the board, vice-president, general/corporate counsel or any such other officers as may be prescribed by the formation documents. (Note: A Multi-jurisdictional Personal History Disclosure Form must be completed by every person noted below. In addition, the Commission may, in its discretion, order additional persons associated with the business entity to file such a form if It appears that such persons should be qualified in order to effectuate the purposes of the Casino Control Act.) DATES NAME AND HOME ADDRESS TITLE OFFICE HELD BUSINESS ADDRESS DATE OF BIRTH FROM | TO INITIALS DATE; ITEM 8. FORMER OFFICERS Use Attachment 8 to provide the following information for each person, not listed in response to Item 7, who was an officer of the business entity during the last 10 year period. Officers include all persons serving as president, secretary, treasurer, chairman of the board, vice-president or any such other offices as may be prescribed by the formation documents. DATES NAME AND LAST KNOWN PRESENT OCCUPATION AND HOME ADDRESS OFFICE HELD We rae 7 BUSINESS ADDRESS DATE OF BIRTH ITEM 9. COMPENSATION OF OFFICERS AND DIRECTORS Use Attachment 9 to provide the following information regarding the amount of total annual compensation received during the last calendar year and the amount to be received during the subsequent calendar year by each director, trustee, and officer, of the business entity, whether such compensation is in the form of salary, wages, commissions, fees, securities or other ownership interest, bonuses or otherwise. | NAME COMPENSATION LAST CALENDAR YEAR | COMPENSATION SUBSEQUENT CALENDAR YEAR FORM OF COMPENSATION | ITEM 10. COMPENSATION OVER $100,000 Use Attachment 10 to provide the following information for each person, other than those listed in response to Item 9, who currently receives, or who reasonably can be expected to receive within one calendar year from the date of this form, compensation as deseribed In Item 9 that exceeds $100,000 per year. POSITION AND LENGTH OF TIME AMOUNT OF NAME DATE OF BIRTH BUSINESS ADDRESS EMPLOYED WITH THE BUSINESS ENTITY COMPENSATION INITIALS DATE: ITEM 11. BONUS, PROFIT SHARING, PENSION, RETIREMENT, DEFERRED COMPENSATION AND SIMILAR PLANS Provide as Attachment 11, a description of all bonus, profit sharing, pension, retirement, deferred compensation and similar plans in existence or to be created by the business entity. This description shall include, but not be limitedto: the title or name of the plan; the identity and address of the trustee of the plan or the person administering the plan; the material features of the plan; the methods of financing the plan; the identity of each class of person who is or will participant in the plan; the approximate number of persons in each such class; and the amounts distributed under the plan to each class of persons during the last fiscal year, if the plan was in effect during that time. ITEM 12. SECURITY OR OTHER OWNERSHIP INTEREST DESCRIPTION Describe the nature, type, number of authorized and issued shares, terms, conditions, rights and privileges of all classes of voting, nonvoting and security or other ownership interest issued, or to be issued, by the business entity, including the number of shares of each class of security or other ownership interest authorized or to be authorized and the number of shares of each class of security or other ownership interest outstanding (i,¢., not held by or on behalf of the issuer) as of thisdate, ME win If the right of holders of any class of security or other ownership interest may be modified otherwise than by a vote of a majority or more of the outstanding shares so affected, voting as a class, so state and explain briefly: INITIALS DATE: ITEM 13. VOTING SHAREHOLDERS Use Attachment 13 to provide the following information for each person or entity holding of record or having a beneficial interest in any voting securities or other ownership interest issued by the business entity. This information must be provided as of a date no more than 60 days prior to the date of this application. (Note: If the business entity submitting this form is an applicant for a casino license, or is a nonpublic holding or intermediary company of such an applicant, then a completed Multi-jurisdictional Personal History Disclosure Form or Business Entity Disclosure Form, as the case may be, must be filed for each person or entity holding or having a beneficial interest in the voting securities or other ownership interest of the business entity. If the business entity submitting this form is a publicly-traded holding company of an applicant for a casino license, then a completed Multi-jurisdictional Personal History Disclosure Form or Business Entity Disclosure Form, as the case may be, must be filed for each person or entity holding or having a beneficial interest in the voting securities or other ownership interest of the business entity unless the Commission has granted a waiver of the qualification requirement as to such persons orentity). CLASS OF VOTING SECURITIES OR NUMBER OF % OF OUTSTANDING VOTING SECURITIES OR NAME ANO HOME ADDRESS DATE OF BIRTH OTHER OWNERSHIP INTEREST HELD SHARES HELO OTHER OWNERSHIP INTEREST HELD ITEM 14. NON-VOTING SHAREHOLDERS Use Attachment 14 to provide the following information for each person or entity holding of record or having a beneficial interest in any nonvoting securities or other ownership interest issued by the business entity. This information must be provided as of a date no more than 60 days prior to the date of this application. (Note: If the business entity submitting this form is an applicant for a casino license, or Is a nonpublic holding or intermediary company of such an applicant, then a completed Multi-jurisdictional Personal History Disclosure Form or Business Entity Disclosure Form, as the case may be, must be filed for each person or entity holding or having a beneficial Interest In the nonvoting Securities or other ownership interest of the business entity. If the business entity submitting this form is a publicly-traded holding company of an applicant for a casino license, then a completed Multi-jurisdictional Personal History Disclosure Form or Business Entity Disclosure Form, as the case may be, must be filed for each person or entity holding or having a beneficial interest in the nonvoting securities or other ownership Interest of the business entity, unless the Commission has granted a waiver of the qualification requirement as to such persons orentity), CLASS OF NONVOTING SECURITIESOR | NUMBEROF % OF OUTSTANDING NONVOTING SECURITIES OR NAME AND HOME ADDRESS DATE OF BIRTH OTHER OWNERSHIP INTEREST HELD SHARES HELD OTHER OWNERSHIP INTEREST HELD INITIALS ou DATE: ITEM 15. DESCRIPTION OF LONG TERM DEBT Provide as Attachment 15, a description of the nature, type, terms, covenants, conditions and priorities of all outstanding bonds, loans, mortgages, trust deeds, notes, debentures, or other forms of indebtedness issued or executed {including loans made by shareholders, or to be issued or executed by the business entity, which mature more than one year from the date of issuance or which, by their terms, are renewable for a period of more than one year from the date of issuance (or, in the space below, provide a specific cross-reference to the applicable document(s) filed with this application that contain(s) all of the requested information. ITEM 16. HOLDERS OF LONG TERM DEBT Use Attachment 16 to provide the following information for each person or entity holding any outstanding bonds, loans, mortgages, trust deeds, notes, debentures, or other forms of indebtedness executed or issued by the business entity, which mature more than one year from the dateof issuance or which, by their terms, are renewable for a period of more than one year from the date of issuance. (Note: Some or all of the persons or entities listed below may be required by the Commission to submit a completed Multi-jurisdictional Personal History Disclosure Form or Business Entity Disclosure Form, as the case may be.) DOLLAR AMOUNT OF DEBT HELD NAME AND ADORESS DATE OF BIRTH TYPE AND CLASS OF DEBT INSTRUMENT HELD (Both Original Amount and Current Balance) ITEM 17. OTHER INDEBTEDNESS AND SECURITY DEVICES Provide as Attachment 17, a description of the nature, type, terms, conditions and covenants of all outstanding loans, mortgages, trust deeds, pledges, lines of credit, or other evidence of indebtedness or security devices utilized by the business entity other than those described In response to Items 15 and 16 (or, in the space below, provide a specific cross-reference to the applicable document(s) filed with this application that contain(s) all of the requested information). ITEM 18. HOLDERS OF OTHER INDEBTEDNESS Use Attachment 18 to provide the following information with respect to each holder of any outstanding loan, mortgage, trust deed, pledge or other evidence of indebtedness or security device described in response to Item 17. (Note: Some or all of the persons listed in response to this item may be required by the Commission to submit a completed Multi-jurisdictional Personal History Disclosure Form or Business Entity Disclosure Form, as the case may be). DOLLAR AMOUNT OF DEBT HELD A\ U | NAME AND ADDRESS DATE OF BIRTH TYPE OF DEBT INSTRUMENT HELD | Both Original Amount and Current Balance | INITIALS DATE: ITEM 19. SECURITIES OPTIONS A. Provide as Attachment 19A, a detailed description of any options existing or to be created with respect to securities issued by the business entity, which description shall include, but not be limited to, the title and amount of securities subject to option, the year or years during which the options were or will be granted, the conditions under which the options were or will be granted, the consideration for granting the option and the year or years during which, and the terms under which, optionees became or will become, entitled to exercise the options, and when such options expire (or include as Attachment 19A copies of any outstanding option plans or proxy statements that provide the requested information). (Note: For the purpose of this application, option shall mean right, warrant or option to subscribe to or purchase any securities issued by the business entity). B. Use Attachment 19B to provide the following information regarding all persons holding the options described in Item 19A. NAME BENEFICIAL OWNER’S ADDRESS OPTIONS HELD | MARKET VALUE (AT ISSUANCE) ITEM 20. FINANCIAL INSTITUTIONS Use Attachment 20 to provide the following information with respect to each bank, savings and loan association or other financial institution, whether domestic or foreign, in which the business entity has or has had an account over the last 10 year period, regardless of whether such account was held in the name of the business entity, a nominee of the business entity or was otherwise under the direct or indirect control of the business entity. IME PERIG NTH [ NAME AND ADDRESS TYPE OF ACCOUNT(S) ACCOUNT NUMBER(S) TOM 7 ITEM 21. CONTRACTS AND SUPPLIERS Use Attachment 21 to provide the following information with respect to all persons with whom the business entity has contracts or agreements of $100,000 or more in value or from whom the business entity has received $100,000 or more in goods or services in the past six manths. Employment contracts need only be listed if, by their terms, they exceed one year induration. | NAME ADDRESS NATURE OF CONTRACT OH GOODS OR SERVICES SUPPLIED | INITIALS _ DATE: ITEM 22. SECURITIES OR OTHER OWNERSHIP INTEREST HELD BY THE BUSINESS ENTITY Use Attachment 22 to provide the following information about each company in which the business entity holds shares or an interest. TYPE OF SECURITIES OR OTHER % OF OWNERSHIP NAME AND ADDRESS OF COMPANY OWNERSHIP INTEREST HELD PURCHASE PRICE PER SHARE OR INTEREST NUMBER OF SHARES HELD MORE THAN S% ITEM 23. INSIDER TRANSACTIONS Use Attachment 23 to provide the following information for each change that occurred within the last five years preceding this application in the beneficial ownership of a business entity on the part of any person who is indirectly or directly a beneficial owner of 10 percent or more of any class of securities or other ownership interest in the business entity or who is or was within that period a director or officer of the business entity. (Include changes resulting from (a) gift; (b) purchase; (c) sale; (d) exercise of an option to purchase; (e) exercise of an option to sell; (f) grant or receipt of a put; or (g) grant or receipt of acall). PARTIES TO TRANSACTION [ DATE OF TRANSACTION NATURE OF TRANSACTION (INCLUDE POSITIONS) NAMES OF SECURITIES INVOLVED | INITIALS DATE: ITEM 24, CRIMINAL HISTORY The next question asks about any charges or offenses the business entity or any of its directors, trustees or officers may have committed or had filed against them. Prior to answering this question, carefully review the definitions and instructions that follow. Definitions for purposes of this question: A. Instructions: 1. 2, “Charge” includes any indictment, complaint, information, summons, or other notice of the alleged commission of any “ ” offense. “Offense” includes all felonies, crimes, high misdemeanors, disorderly persons offenses, and petty disorderly persons offenses. Answer “Yes” and provide all information, to the best of your ability, EVEN IF: A. The business entity, its directors, trustees, or officers did not commit the offense charged; B. The charges were dismissed; c. The business entity, its directors, trustees, or officers were not convicted; or Dd, The charges er offenses happened a long time ago. Answer “No” if the records relating to the charges have been expunged or sealed by court order, Has the business entity or any of Its subsidiaries, directors, trustees, or officers ever been indicted, charged with or convicted of a criminal or disorderly person’s offense or been a party to or named as an unindicted co-conspirator in any criminal proceeding in this state or any other Jurisdiction? fives GNo If yes, use Attachment 24 to provide the following information for each indictment, charge or conviction: NAME AND ADDRESS OF DISPOSITION yond — - appeal mr cune OR | LAW ENFORCEMENT AGENCY (ACQUITTED, CONVICTED, SENTENCE OR COURT INVOLVED DISMISSED, ETE.) INITIALS ___ DATE: ITEM 25, Has the business entity, any of its subsidlarles, directors, trustees or officers ever refused to testify before, been the subject of an investigation conducted by, or raquested to take a polygraph exam by, any governmental agency, court, committee, grand jury or investigatory body (municipal, state, county, province, federal, national, ete.), other than In response to minor traffic-related offenses? (Yes CINo If yes, use Attachment 25 to provide the following information about any such testimony, investigation or polygraph exam: NAME AND ADDRESS GF COURT OR BATE ON WHICH APPROXIMATE TIME PERIOD OF OTHER AGENCY NATURE OF PROCEEDINGS OR INVESTIGATION WAS TESTIMONY GIVEN? TESTIMONY WAS GIVEN INVESTIGATION ITEM 26, Has the business entity, any of Its subsidiaries, directors, trustees or officers ever refused to testify before, to answer a question asked by, or to take a polygraph exam administered by any governmental agency, court, committee, grand jury or investigatory body (municipal, state, county, province, federal, national,ete.)? ClYes (No If yes, use Attachment 26 to provide the following information about any such testimony, investigation or polygraph refusal: CIVIL OR CRIMINAL NAME AND ADDRESS OF COURT OR DATE OF PROCEEDINGS / DISPOSITION OF Sis keeic NATURE OF PROCEEDINGS ORINVESTIGATION phelitpacrcn CONTEMPT TATION? CONTEMPT CITATION ITEM 27. EXISTING LITIGATION Provide as Attachment 27, a description of all existing civil litigation to which the business entity, its parent or any subsidiary, Is presently a party, whether in this state or in another jurisdiction. Do not include any litigation in which the damages may not reasonably be expected to exceed $100,000, or litigation in which damages may be expected to exceed $100,000, but which involve claims agalnst the business entity which are fully and completely covered under an insurance policy held by the business entity with a licensed insurance earrler, This deseription must include the title and docket number of the litigation, the name and location of the court before whieh it is pending, the Identity of all parties to the litigation, and the general nature of all claims beingmade. INITIALS _. DATE: ITEM 28. A Has the business entity ever had a judgment, order, consent decree or consent order, pertaining to a violation or alleged violation of the federal antitrust, trade regulation or securities laws, or similar laws of any state, province or country entered against it? Oves ONo 8, In the past 10 years, has the business entity had a Judgment, order, consent decree or consent order, pertaining to a violation or alleged violation of any state or federal statute, regulation or code that resulted Ina fine or penalty of $50,000 or more, entered against it? Gives GNo if yes to elther question, use Attachment 28 to provide the following Information for each judgment, order, consent decree or consent order: | TITLE OF CASE | NAME AND ADDRESS DATE OF OFFENSE | NATURE OF GFFENSE AND DOCKET NUMBER OF COURT OR AGENCY NATURE GF JUDGMENT, DECREE ORORDER DATE ENTERED | ITEM 29, Has the business entity, its parent or any Intermediary company, had any petition under any provision of the Federal Bankruptcy Code or under any state Insolvency law, filed by or against It In the last 10-year period? OYes No A. Has the business entity, its parent or any intermediary company, sought relief under any provision of the Federal Bankruptcy Code or under any state insolvency law in the last 10-year perlod? GYes No If yes to either question, use Attachment 294 to provide the following Information for each bankruptcy or Insolvency preceeding: DATE PETITION FILED OR RELIEF SOUGHT THEE OF CASE AND BGCIET NURIGER NAME AND ADDRESS OF COURT OR AGENCY NATURE OF JUDGMENT OR RELIEF DATE ENTERED INITIALS DATE: ITEM 29. B. Has any receiver, fiscal agent, trustee, reorganization trustee or similar officer, been appointed In the last 10-year period by a court for the business or property of the business entity or Its parent, holding, Intermediary or subsidiary companies? GYes No If yes to any of the above questions, use Attachment 29C to provide the following information for each proceeding: | _NAME OF PERSON APPOINTED | __DaTe APPOINTED | COURT | REASON FOR APPOINTMENT | ITEM 30. LICENSES A. During the last 10-year period, has the business entity, its parent or any subsidiary, ever had any license or caertifleate Issued bya government agency in this state or any other Jurisdiction, denied, suspended orrevoked? Yes (No If yes, use Attachment 30A to provide the fallowing Information for each license or certificate denied, suspended or revoked: NAME AND LOCATION OF | | [ TYPE OF LICENSE OR CERTIFICATE GOVERNMENTAL AGENCY | AGTION TAKEN bate REASON FOR ACTION TAKEN B. Has the business entity, its parent or any subsidiary, ever applied in any jurisdiction for a license, permit, or other authorization, to participate In lawful gambling operations (including casino gaming, horse racing, dog racing, pari-rutuel operation, lottery, sports betting, ete.)? GYes GINo If yes, use Attachment 308 to provide the following information for each license, permit or other authorization applied for: IF ISSUED, GIVE APPROPRIATE DISPOSITION LICENSE, PERMIT, OR OTHER SUCH NAME AND ADDRESS OF LICENSING AGENCY DATE OF APPLICATION (GRANTED, DENIED, PENDING) TYPE OF GAMBLING ACTIVITY NUMBER, AND THE EXPIRATION __DATE INITIALS DATE: ITEM 31. CONTRIBUTIONS AND DISBURSEMENTS OF BUSINESS ENTITY A. During the last 10-year period, has the business entity, its parent or any subsidiary, director, officer or employee, or any third party acting for or on behalf of the business entity, made any bribes or kickbacks or made any payments alleged to have been bribes or kickbacks to any employee, company or organization to obtain favorable treatment? OYes ONo During the last 10-year period, has the business entity, its parent or any subsidiary, director, officer or employee, or any third party acting for or on behalf of the business entity, made any bribes or kickbacks or made any payments alleged to have been bribes or kickbacks to any government official, domestic or foreign, to obtain favorable treatment? fives OGINo During the last 10-year period, has the business entity, Its parent, any subsidiary or related entity or individual, donated or loaned funds, for the purpose of opposing or supporting any government, political party, candidate or committee, either domestic or foreign? OYes ONo During the last 10-year period, has the business entity, Its parent company, any subsidiary or related entity or individual, donated or loaned property or any other thing of value, for the purpose of opposing or supporting any government, political party, candidate or committee, either domestic or foreign? OYes ONo During the last 10-year period, did the business entity, its parent or any subsidiary, make any loans, donations or other disbursements, to directors, officers or ernployees, for the purpose of making political contributions, either domestic or foreign? OYes ONo During the last 10-year period, has the business entity, its parent or any subsidiary, make any loans, donations or other disbursements, to directors, officers or employees, for the purpose of reimbursing such Individuals for political contributions, either domestic or foreign? OYes GNo During the last 10-year period, has the business entity, its parent or any subsidiary, maintained any bank account, domestic or foreign, not reflected on the business entity’s books orrecords? OYes fNo During the last 10-year period, has the business entity, its parent or any subsidiary, maintained any numbered account or any account, in the name of a nominee for the business entity? OYes GNo List the names and addresses of any present or former directors, officers, employees, or third parties, who would have knowledge or Information concerning the questions affirmatively answered under this Item: INITIALS DATE: ITEM 32. FINANCIAL STATEMENTS A. Provide as Attachment 32A, an audited financial statement which shall include but not be limited to, an income statement, balance sheet, statement of sources, and application of funds and all notes to such statements and related financial schedules, for the last fiscal year prepared in accordance with the Securities Act of 1933, the Securities Exchange Act of 1934, the Public Utility Holding Company Act of 1935, and the Investment Company Act of 1940. B. Provide as Attachment 328, copies of all financial statements prepared in the last five years, with respect to the business entity and any exceptions taken to such statements by the independent auditor retained by the business entity and the management response thereto. ITEM 33. ANNUAL REPORTS A. Provide as Attachment 33A, a copy of all annual reports of the business entity that were submitted to shareholders or other persons during the last five years. B. In addition to the information required in Item 33A, a business entity that is a registrant under the Securities Act of 1933 or the Securities Exchange Act of 1934, is to submit a copy of all annual reports prepared on Form 10K, pursuant to Sections 13 or 15(d) of the Securities Exchange Act of 1934 and filed within the last five years. Identify these as Attachment33B. ITEM 34. QUARTERLY REPORTS Provide as Attachment 34, a copy of the last quarterly, unaudited financial statements prepared by or for the business entity. If the business entity is a registrant with the Securities and Exchange Commission (SEC), a copy of the Form 10Q last filed with the SEC may be provided in response to thisitem. ITEM 35. INTERIM REPORTS Provide as Attachment 35, a copy of any current report prepared due to the occurrence of any of the following events: change in contro! of the business entity; acquisition or disposition of assets; bankruptcy or receivership proceedings; changes in the business entity's certifying accountant or other material events. If the business entity is a registrant with the SEC, a copy of the most recent Form 8K filed with the SEC may be provided in response to this item. ITEM 36. PROXY AND INFORMATION STATEMENT Provide as Attachment 36, a copy of the last definitive Proxy or Information Statement filed pursuant to Section 14 of the Securities Exchange Act of 1934. ITEM 37. REGISTRATION STATEMENT Provide as Attachment 37, a copy of all Registration Statements filed in the last five years pursuant to the Securities Act of 1933. INITIALS DATE: __ ITEM 38. REPORTS OF ACCOUNTANTS Provide as Attachment 38, a copy of all reports and correspondence, other than those previously included in this application, submitted in the last five years by independent auditors for the business entity which pertain to the issuance of financial statements, managerial advisory services, or internal control recommendations. Include the name, address and telephone number of the current outside auditor(s). ITEM 39. FORMATION DOCUMENTS Provide as Attachment 39, a certified copy of the Articles of Incorporation, Charter and Bylaws of the corporation, the partnership agreement of the partnership, or formation documents of the business entity, as applicable, with all amendments and proposed amendments to date. Highlight the portions of these documents that comply with the requirements of the Virgin Islands Casino and Resort Control Act of 1995. ITEM 40. ORGANIZATIONAL CHART A. Provide as Attachment 40A, a current ownership organizational chart of the business entity, its parent company and each subsidiary of the business entity. B. Provide as Attachment 40B, a functional Table of Organization for the business entity filing this Business Entity Disclosure Form, including position descriptions and the names of persons holding such positions. ITEM 41. TAX RETURNS Provide as Attachment 41, a copy of all 1120 Forms (U.S. Corporate Income Tax Return ), 1065 (Partnership Tax Return Limited Liability Company Return) and 941 Forms (Employer’s Quarterly Federal Tax Return) as applicable, submitted to the Internal Revenue Service in the last five years. INITIALS DATE: ITEM 42. BUSINESS ENTITY DISCLOSURE FORM —ATTACHMENTS On the following chart, indicate with a checkmark which attach If an attachment is not applicable, indicate N/A. Please note t (*) are attachments you are to provide or create and do not con ments are included with this application, hat attachment numbers with an asterisk tain corresponding charts. Attachment ‘ V ifattached Number selects Daantiption N/A if not attached 18 Incorporators or founding persons 28 Other names and addresses of the business entity (presentiyused) 2c Other names and addresses of the business entity (past 10 years) <b Description of business done and intended to he dane 4* Description of any former business engaged in during the last 10 years and the reason for the cessation of the business 5 Directors and trustees 6 Former directors and trustees 7 Officers 8 Former officers E} Compensation of officers and directors 10 Compensation over $100,000 11° Description of all bonus, profit sharing, pension, retirement, deferred compensation, and similar plans 13 Voting shareholders 14 Nonvoting shareholders 15* Description of long-term debt 16 Holders of long-term debt 17* Other indebtedness and security devices 18 Holders of other indebtedness 19A* Securities options — description 19B Persons holding securities options 20 Financial institutions 21 Contracts and suppliers 22 Securities or other ownership interest held by tha businessentity 23 Insider transactions 24 Criminal history 25 Testimony, investigations or polygraphs 26 Testimony, investigations or polygraphrefusals a7 Existing litigation 28 Antitrust, trade regulations and securities judgments, statutory and regulatory violations 29A Bankruptcy or insolvency proceedings and appointed receiver, agent or trustee (bankruptcy or insolvency) 29C Bankruptcy or insolvency proceedings and appointed Feceiver, agent or trustee (appointed receiver, agent or trustee) 30A Licenses (Government) 30B Licenses (other gambling) 32A* Audited financial statements for the last fiscal year 32B* Financial statements for the last fiveyears 33A* Annual reports for the last fiveyears 338* Annual reports prepared on the SEC’s Form 10K far the last five years 34* A copy of the last quarterly unaudited financial statement 35* Copy(ies) of any interim reports 36* A copy of the last definitive proxy or information staternent (SEC) 37* A copy of all registration statements for the last five years filed in aceerdance with the Securities Act of 1933 38* Copies of all other reports prepared in the last fiva yaars by Independent auditors of the business entity 39* Formation documents and all amendments and proposed amendments 40A* Current ownership table of organization 408* Functional table of organization for business entity filing this form, Job deseriptions and names of employees 41* Copies of forms filed with the IRS in the last five years INITIALS DATE: ITEM 43. AFFIDAVITS AND SIGNATURES Pursuant to the regulations of the Virgin Islands Casino Control Commission, this form must be sworn to or affirmed, signed and dated, before a person legally competent to take an oath or affirmation, who shall himself date the signature of the affiant and indicate the basis of his authority to take oaths and affirmations. The documents on pages 20 through 23 are to be signed in accordance with these regulations. The documents are: © AFFIDAVIT © RELEASE AUTHORIZATION ©) CONSENT TO INSPECTIONS, SEARCHES AND SEIZURES O WAIVER OF LIABILITY The President or any officer of the business entity authorized to affirm may complete the affidavit. The remaining documents are to be signed by the President or Chief Executive Officer. INITIALS _ DATE: STATE OF STATEMENT OF TRUTH COUNTY OF SS: ~-— SS , the NAME TITLE/POSITION of the business entity, being duly sworn according to law, on my oath, deposes and says that | make this statement on behalf of the business entity, and that the above statements are true and correct to the best of my knowledge and belief, and that this statement is executed with the knowledge that any risrepresentation or failure to reveal | nformation may be deemed sufficient cause for the refusal to issue, or the revocation of, a license. Further, that | arn voluntarily submitting this statement and understand that misleading statements may subject me to criminal or other sanctions or punishment, Subscribed and sworn to before me this Name of Business Entity Signature Date Title Accountant Preparing Form, if any day of , 20 NOTARY PUBLIC Attorney Preparing Form, if any Commission Expiration Date Notary License Number SEAL INITIALS DATE: RELEASE AUTHORIZATION TO: All Courts, Probation Departments, Selective Service Boards, Employers, Educational Institutions, Banks, Financial and other such Institutions and all Governmental Agencies - Federal, State and local, without exception, both foreign and domestic On behalf of NAME OF BUSINESS ENTITY \, , have authorized NAME OF PRESIDENT OR CHIEF EXECUTIVE OFFICER the Virgin Islands Casino Control Commission to conduct a full investigation into the background of said business entity. Therefore, you are hereby authorized to release any and all information pertaining to the said business entity, documentary or otherwise, as requested by any employee, agent or representative of the Virgin Islands Casino Control Commission, provided that he or she certifies to you that said business entity has an application pending before Virgin Islands Casino Control Commission or Division of Gaming Enforcement or that said business entity is presently a licensee or registrant required to be qualified under the provisions of the Casino Control Act. This authorization shall supersede and countermand any prior request or authorization to the contrary. A photocopy of this authorization will be considered as effective and valid as the original, Signature Date Subscribed and sworn to before me this___day of , 20 NOTARY PUBLIC Commission Expiration Date Notary License Number SEAL INITIALS DATE: CONSENT TO INSPECTIONS, SEARCHES AND SEIZURES On behalf of NAME OF BUSINESS ENTITY \, , hereby consent to NAME OF PRESIDENT OR CHIEF EXECUTIVE OFFICER all inspections, searches and selzures and the supplying of handwriting exemplars as authorized by the Casino Control Act and by the rules and regulations of the Virgin Islands Casino Control Commission. The said business is aware of its right, secured by the Constitution of the United States, and by the Revised Organic Act of 1954, and the Virgin Islands Code not to consent to such inspections, searches and seizures and | expressly waive and forego that right on behalf of said business entity. Signature Date Subscribed and sworn to before me this day of , 20 NOTARY PUBLIC Commission Expiration Date Notary License Number SEAL INITIALS DATE: WAIVER OF LIABILITY On behalf of NAME OF BUSINESS ENTITY \, , hereby waive liability NAME OF PRESIDENT OR CHIEF EXECUTIVE OFFICER as to the US Virgin Islands and its instrumentalities and agents, for any damages resulting to the said business entity from any disclosure or publication in any manner, other than a willfully, unlawful disclosure or publication, of any material or information acquired during the licensing process or during any inquiries, investigations or hearings. Signature Date Subscribed and sworn to before me this day of , 20 . NOTARY PUBLIC Commission Expiration Date Notary License Number SEAL INITIALS DATE: ATTACHMENT 18 INCORPORATORS OR FOUNDING PERSONS NAME ~ LAST KNOWN ADORESS OCCUPATION(S) DATE OF BIRTH Attachment 18: Page___of___ Pages INITIALS _.. DATE: ATTACHMENT 28 PLE I INAV! NU AUDR NES a8 BER sit NAME NUMBER AND STREET ciry STATE ZIP CODE Attachment 28: Page ____of__ Pages INITIALS _ DATE: ATTACHMENT 2€ UTHER NAM NOU ADD TH OATES NAME NUMBER ANO STREET cry ; STATE FROM zip Sone: Attachment 2C: Page____of___ Pages INITIALS ___ DATE: ATTACHMENT 3 DESCRIPTION OF PRESENT BUSINESS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 3; Page of Pages INITIALS _ as DATE! ITEM 4, DESCRIPTION OF FORMER BUSINESS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 4: Page of. INITIALS __ DATE: Pages ATTACHMENT 5 DIRECTORS, TRUSTEES DATES DINECTORSHIP OR NAME AND HOME ADDRESS BUSINESS ADDRESS TRUSTEESHIP HELO OCCUPATION OR TITLE, POSITION OR ASSOCIATION DATE OF BIRTH WITH THE BUSINESS ENTITY FROM | To Attachment 5: Page___of____ Pages INITIALS _ DATE: _ STE = ES STEEETES Foe: ATTACHMENT 6 FORMER DIRECTORS, TRUSTEES OCCUPATION AND DATES DIRECTORSHIP OR NAME AND HOME ADDRESS BUSINESS ADDRESS __ TRUSTEESHIP HELD DATE OF BIRTH REASON FOR LEAVING FROM TO si Attachment 6: Page____of___ Pages INITIALS DATE: <== —= eneraeee ATTACHMENT 7 OFFICERS NAME ANO HOME ADDRESS TT [_DATES OFFICE HELD BUSINESS ADDRESS DATE OF BIRTH FROM TO Cc Cc — = Cc C Cc C Cc Cc Cc Cc Cc C Cc Cc Cc Cc Cc Cc Cc Cc c Cc c Cc c c c Cc Attachment 7: Page____of___ Pages INITIALS _____s DATE: ATTACHMENT 8 FORMER OFFICERS NAME AND LAST KNOWN DATES OFFICE HELD PRESENT OCCUPATION HOME ADORESS OFFICE HELO AND BUSINESS ADDRESS = DATE OF BIRTH FROM ic) Attachment 8: Page__of___ Pages INITIALS _ DATE: ATTACHMENT 9 COMPENSATION OF OFFICERS ANO DIRECTORS NAME. COMPENSATION LAST CALENDAR YEAR COMPENSATION SUBSEQUENT CALENDAR YEAR data wae FORM OF COMPENSATION Attachment 9: Page____of__ Pages INITIALS DATE: ATTACHMENT 10 COMPENSATION OVER $100,000 Fee POSITION AND LENGTH OF TIME EMPLOYED AMOUNT OF NAME od. OATE OF BIRTH alr ee BUSINESS ADDRESS ; i. WITH THE BUSINESS ENTITY __ COMPENSATION _ Attachment 10: Page_____of____ Pages INITIALS _____s DATE: ITEM 11. B ———s— ee a SS SSE ESE EECA ANY SIVIILAR FLAND ONUS, PROFIT SHARING, PENSION, RETIREMENT, DEFERRED COMPENSATION AND SIMILAR PLANS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 11: Page__of__ Pages INITIALS ___ DATE: = ATTACHMENT 13 VOTING SHAREHOLDERS NAME AND HOME ADDRESS DATE OF BIRTH CLASS OF VOTING SECURITIES OR NUMBER OF SHARES HELD % OF OUTSTANDING VOTING OTHER OWNERSHIP INTEREST HELO SECURITIES OR OTHER oer 7 OWNERSHIP INTEREST HELD Attachment 13: Page of___Pages INITIALS ss DATE: _ ATTACHMENT 14 NONVOTING SHAREHOLDERS CLASS OF NONVOTING SECURITIES OR 7 NAME AND HOME ADDRESS — DATE OF BI RTH % OF OUTSTANDING NONVOTING SECURITIES __OTHER OWNERSHIP INTEREST HELD NUMBER OF SHARES HELD OR OTHER OWNERSHIP INTEREST HELD Attachment 14: Page____of___ Pages INITIALS ee _ DATE: = ITEM 15. DESCRIPTION OF LONG TERM DEBT INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 15; Page____of___ Pages INITIALS DATE: ATTACHMENT 16 HOLDERS OF LONG TERM DEBT NAME AND ADDRESS “DATE OF BIRTH TYPE AND CLASS OF DEBT INSTRUMENT HELO (Both Original Amount and Current Balance) DOLLAR AMOUNT OF DEBT HELD Attachment 16: Page of____Pages INITIALS DATE: ITEM 17. OTHER INDEBTEDNESS AND SECURITY DEVICES INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 17: Page. of. INITIALS DATE: Pages ATTACHMENT 18 HOLDERS OF OTHER INDEBTEDNESS NAME AND ADDRESS DATE OF BIRTH TYPE OF DEBT INSTRUMENT HELD DOLLAR AMOUNT OF DEBT HELO ne: pofd ties = _(Both Original Amount and Current Balance) | | Attachment 18: Page. of___ Pages INITIALS DATE: ___ ITEM 19A. SECURITIES OPTIONS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 19A; Page___of___ Pages INITIALS DATE: ATTACHMENT 198 PERSONS HOLDING SECURITIES OPTIONS NAME BENEFICIAL OWNER’S ADDRESS OPTIONS HELO i MARKET VALUE AT ISSUANCE Attachment 19B: Page___of___ Pages INITIALS ____ DATE: ATTACHMENT 20 FINANCIAL INSTITUTIONS NAME AND ADDRESS TYPE OF ACCOUNT(S) ACCOUNT NUMBER(S) TIME PERIOD ACCOUNT HELD FROM ___TO Attachment 20: Page____of__ Pages INITIALS DATE: ATTACHMENT 21 CONTRACTS AND SUPPLIERS NAME. ADDRESS OF CONTRA QODS O ———— LIED sii Attachment 21: Page___of___ Pages INITIALS DATE: __ ATTACHMENT 22 SECURITIES OR OTHER OWNERSHIP INTEREST HELD BY THE BUSINESS ENTITY TYPE OF OWNERSHIP OR OTHER % OF OWNERSHIP NAME AND HOME ADORESS OF COMPANY OWNERSHIP INTEREST HELD PURCHASE PRICE PER SHARE NUMBER OF SHARES HELD MORE THAN 5% Attachment 22: Page____of___ Pages INITIALS ss DATE: __ ATTACHMENT 23 INSIDER TRANSACTIONS DATE OF TRANSACTION eennnnnnnemeieeeineee ee ee NATURE OF TRANSACTION PARTIES TO TRANSACTION (INCLUDE POSITIONS) : NUMBER OF SECURITIES INVOLVED +... Se Attachment 23: Page___of___ Pages INITIALS DATE: __ ATTACHMENT 24 CRIMINAL HISTORY NAME OF CASE NATURE OF CHARGE NAME AND ADDRESS OF DISPOSITION DATE OF CHARGE LAW ENFORCEMENT AGENCY AND DOCKET NUMBER OR COMPLAINT OR COMPLAINT (ACQUITTED, CONVICTED, OR COURT INVOLVED DISMISSED, ETC.) aan Attachment 24: Page___of___ Pages INITIALS ___ DATES... ATTACHMENT 25 TESTIMONY, INVESTIGATIONS OR POLYGRAPHS So _ -—- a NATURE OF PROCEEDINGS DATE ON WHICH TESTIMONY APPROXIMATE TIME PERIOD NAME AND ADDRESS OF COURT OR OTHER AGENCY OR INVESTIGATION WAS TESTIMONY GIVEN? WASGIVEN ; OF INVESTIGATION Attachment 25: Page____of___ Pages INITIALS DATE: ATTACHMENT 26 TESTIMONY, INVESTIGATIONS OR POLYGRAPH REFUSALS NAME AND AOORESS OF COURT OR OTHERAGENCY NATURE OF PROCEEDINGS OR INVESTIGATION Sea Ee DATE OF PROCEEDINGS OR INVESTIGATION CIVIL OR CRIMINAL CONTEMPT DISPOSITION OF CITATION? (SPECIFY) CONTEMPT CITATION Attachment 26: Page___of____ Pages INITIALS DATE: ATTACHMENT 27 EXISTING LITIGATION CASE NUMBER _ TITLE AND COURT GENERAL NATURE LOCATION __ Attachment 27: Page___of___ Pages INITIALS DATE: ATTACHMENT 28 PAIN ON AND alll JGM Nt STA JTO NUR UK DATE OF OFFENSE TITLE OF CASE ; NATURE OF OFFENSE = AND DOCKET NUMBER NAME AND ADDRESS OF COURT OR AGENCY NATURE OF JUDGMENT, OECREE OR ORDER DATE ENTERED Attachment 28: Page___of__ Pages INITIALS DATE: ATTACHMENT 29A ANAK aw@ik NU) ie. Di AND VIN ’ a DATE PETITION FILED OR RELIEF SOUGHT TITLE OF CASE AND DOCKET NUMBER NAME AND ADDRESS OF COURT OR AGENCY NATURE OF JUDGMENT ORAELIEF DATE ENTERED Attachment 29A: Page of____Pagas INITIALS DATE: ATTACHMENT 29¢ ANAK KR INSU RU elix ANU UIN NAME OF PERSON APPOINTED DATE APPOINTED ~ COURT om FOR APPOINTMENT Attachment 29¢: Page__of___ Pages INITIALS _ DATE: ATTACHMENT 30A LICENSES (GOVERNMENT) TYPE OF LICENSE NAME AND LOCATION OF OR CERTIFICATE GOVERNMENTAL AGENCY __AGTION TAKEN DATE REASON FOR ACTION TAKEN Attachment 30A: Page___of___ Pages INITIALS DATE: ATTACHMENT 308 LICENSES (OTHER GAMBLING) DISPOSITION NAME AND ADDRESS DATE OF APPLICATION IF ISSUED, GIVE APPROPRIATE LICENSE, PERMITOR OF LICENSING AGENCY (GRANTED, DENIED, PENDING) TYPE OF GAMBLING ACT: wn OTHER SUCH NUMBER AND EXPIRATION baTe SS Attachment 30B: Page____of___ Pages INITIALS _ DATE: ITEM 32A. FINANCIAL STATEMENTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 32A: Page____of____ Pages INITIALS DATE: ITEM 32B. FINANCIAL STATEMENTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 32B; Page___of. INITIALS DATE: Pages ITEM 33A. ANNUAL REPORTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 33A: Page___of INITIALS ______- DATE: Pages ITEM 33B. ANNUAL REPORTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 338: Page___of. INITIALS ____ DATE: Pages ITEM 34. QUARTERLY REPORTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 34: Page___of. INITIALS DATE: Pages ITEM 35. INTERIM REPORTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 35: Page___of___ Pages INITIALS DATE: _ ITEM 36. PROXY AND INFORMATION STATEMENT INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 36: Page____of___ Pages INITIALS DATE: ITEM 37. REGISTRATION STATEMENT INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 37; Page___of. INITIALS DATE: Pages ITEM 38. REPORTS OF ACCOUNTANTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 38; Page___of__ Pages INITIALS DATE: ITEM 39. FORMATION DOCUMENTS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 39: Page___ of INITIALS _ DATE: _ Pages ITEM 40A. ORGANIZATIONAL CHART INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 40A: Page___of___ Pages INITIALS DATE: ITEM 408. ORGANIZATIONAL CHART INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 40B: Page____of___ Pages INITIALS DATE: ITEM 41. TAX RETURNS INSERT NARRATIVE OR DOCUMENT(S) HERE Attachment 41; Page. of. INITIALS _ DATE: __ Pages BLANK PAGE