MISSISSIPPI GAMING COMMISSION

APPLICATION FOR

JUNKET REPRESENTATIVE

DEFINITIONS

(Mississippi Gaming Regulations, Ch. 7, Pt. 3, Rule 7.1)

Section 1. Definitions.

(a)	"Collection representative" means any person who may approve or extend gaming credit or collects gaming credit instruments negotiated by a preferred guest. The term does not include:

(1)	Persons holding a Mississippi gaming license or their employees, or

(2)	A bonded collection agency licensed by local government authorities in

the jurisdiction where it has its principal place of business, or

(3)	Any licensed attorney.

(b)	“Complimentary” means a service, item, or accommodation provided to a person at no cost, or at a reduced price not generally available to the public under similar circumstances; however, that term shall include any service, item, or accommodation provided at a reduced price due to the anticipated or actual gaming activities of that person.

(c)	"Junket representative" means any person who contracts with a gaming licensee or its affiliate to provide services consisting of arranging transportation or lodging for preferred guests at a licensed gaming establishment. It also means any person who contracts with a gaming licensee or its affiliate to provide services as a collection representative. The term does not include travel agencies that receive compensation based solely on the price of the transportation or lodging, or permanent full-time employees of a gaming licensee or its affiliates.

(d)	"Preferred guest" means any person, 21 years of age or older, who receives complimentary transportation, food, lodging, entertainment or other consideration with a retail price in excess of $200 from a licensed establishment as an inducement to gamble.

(e)	"Secondary representative" means any person other than clerical personnel or ticket takers not otherwise exempt under subsections (a) or (b) who receives compensation in any form from a junket representative for assisting a junket representative.

INSTRUCTIONS

Thoroughly read this application in its entirety. Application will be imaged. DO NOT STAPLE.

All entries must be neatly printed using blue or black ink.

ALL ENTRIES MUST BE ANSWERED COMPLETELY AND THOROUGHLY. IF ADDITIONAL SPACE IS NEEDED FOR A PARTICULAR RESPONSE, YOU MAY SUPPLEMENT WITH ADDITIONAL PAGES, AS LONG AS YOU INDICATE THE PAGE AND QUESTION NUMBER TO WHICH THE RESPONSE APPLIES.

If a question or entry does not apply to you or your particular situation, indicate by writing “N/A” for your response. You may also include a brief explanation as to why you answered “N/A”.

Review the application.

Date and initial at the bottom of each page where indicated.

SUBMIT THE ORIGINAL APPLICATION AND A COPY OF THE ORIGINAL APPLICATION.

Submit with each Junket application a check or money order for one thousand dollars ($1,000) made payable to the Mississippi Gaming Commission to one of the following addresses:

REGULAR U.S. MAIL ONLY	FedEx or UPS

Mississippi Gaming Commission	Mississippi Gaming Commission

Attention: Records Management	Attention: Records Management

P.O. Box 23577	620 North St., Suite 200

Jackson, MS 39225	Jackson, MS 39202

* The $1,000 payment is NON-REFUNDABLE for any reason. It covers both the permit fee ($500) and the investigative fee ($500).

OTHER IMPORTANT INFORMATION

An applicant for a Junket Representative Permit is seeking the granting of a privilege. The burden of proving qualifications for such a permit is at ALL times on you, the applicant. You must fully cooperate with the investigation and promptly supply all information requested of you.

Applications that are incomplete or otherwise deficient will be returned to you. No further action will be taken on your application until you re-submit a correctly completed application.

You may also be required to file an application for a Finding of Suitability at any time after filing this application. If you are notified to file an application for a Finding of Suitability, you will be required to pay additional investigative fees.

The background investigation typically takes no less than three (3) months to complete and is necessary for a permit to be issued or renewed.

All applicants are advised that this personal record is an official document and misrepresentation or failure to reveal information requested may be deemed to be sufficient cause for the refusal or revocation of a permit.

ATTENTION: Payment by operators to junkets can only be made in the name of the approved individual and/or entity. If you wish to have your company approved in addition to yourself, complete the company information below, else skip to question 5. Please mark N/A for items that are Not Applicable.

Company Information

Name of Entity/Business:___________________________________________________________

Physical Address: _________________________________________________________________________

City: ____________________________ State: ________________ Zip: _____________________________

County___________________________

Business Mailing Address: _________________________________________________________________

City: ____________________________ State: ________________ Zip: _____________________________

County___________________________

Business Telephone Number (_______)_____________________________________

Business Toll Number (_______)_______________________________________

Business Fax Number: (_______)_______________________________________

Tax ID Number ___________________________ E-Mail ____________________________________

STATEMENT OF OWNERSHIP

Is the junket to be operated as a partnership? ----------------------------------------------If yes, go to question 3.

Is the junket to be operated as a corporation or limited liability corporation? --------If yes, go to question 4.

Is the junket to be operated as a sole ownership? -----------------------------------------If yes, go to question 5.

List all partners, home addresses, and extent of their interest in the partnership. Attach a copy of partnership agreement. All partners must complete a separate Junket Application.

Name	Home Address	Interest

List all officers, directors and stockholders, titles in corporation, home address, and total number of shares of stock owned by each in the corporation. Give total number of shares authorized for the corporation. Attach a copy of Articles of Incorporation, Operating Agreement, Corporate Charter, and if not a Mississippi charter, Authority to Do Business in Mississippi.

Name	Title	Home Address	Stock Owned

List all employees, secondary junkets and their job titles

Name	Home Address	Position

Does the Applicant swear/affirm that he/she meets the qualifications for a junket representative as required by the

Mississippi Gaming Control Act?

Yes ( ) No ( )

If no, explain fully _____________________________________________________________________________

_____________________________________________________________________________________________

Does the applicant swear/affirm that as a junket representative, he/she will fully comply with all rules and regulations promulgated by the Commission relative to the Mississippi Gaming Control Act, to keep all records and make all reports and remittances required by the Commission, and to comply with the provisions of the Mississippi Gaming Control Act?

Yes ( ) No ( )

If no, explain fully _____________________________________________________________________________

_____________________________________________________________________________________________

Have you or any member of your partnership or association or any officer, director, or stockholder of your

corporation ever had a license or permit of any kind denied, suspended, or revoked?

Yes ( ) No ( )

If yes, explain fully _____________________________________________________________________________

_____________________________________________________________________________________________

Have you or any member or your partnership or association or any officer, director, or stockholder of your corporation ever been arrested, charged, indicted, or convicted of any drug or gaming related violation?

Yes ( ) No ( )

If yes, explain fully_____________________________________________________________________________

_____________________________________________________________________________________________

Have you or any contract you have held with any casino in any jurisdiction ever been withdrawn, revoked, discharged or terminated for any reason?

Yes ( ) No ( )

If yes, explain fully_____________________________________________________________________________

_____________________________________________________________________________________________

List any casinos and locations in which you currently hold contracts or agreements to do business.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

12. List any other Sole Proprietorship, Corporation, Limited Liability company that you are an owner, member, officer or

are a percentage shareholder over 5%.

Name	Title	Location Percentage

Has your Business been subject to a lawsuit, sanctioned or investigated by a Regulatory agency?

Yes ( ) No ( )

If yes, explain fully _______________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

JUNKET REPRESENTATIVE APPLICATION

PERSONAL RECORD

Type or neatly print an answer to every question. If a question does not apply to you, indicate by writing “N/A”. If there is insufficient space, use a separate sheet and precede each answer with the page and question numbers.

1.	Personal Information:

________________________________________________________________________________________________

Last Name	First Name	Middle Name

__________________________________________________________________________________________________

Alias (nicknames, maiden name(s), other name changes, legal or otherwise)

________________________________________________________________________________________________

Present Residence Address – Street or RFD	Since (date)

________________________________________________________________________________________________

City – Post Office State Zip

_______________________________________________________________________________________________

Present Business Address

_______________________________________________________________________________________________

Occupation

Home Phone ( )___________________ State/DL#____________________________________________

Business Phone ( )____________________	Passport#____________________________________________

____________________________________________________________________________________________

Date of Birth	Social Security Number	Sex	Race

Place of Birth _________________________________________________________________________________

Email Contact address___________________________________________________________________________

________________________________________________________________________________________________

Eye Color Hair Color Complexion Weight	Height	Build

________________________________________________________________________________________________

Scars, Tattoos, or distinguishing marks and/or characteristics

Are you a citizen of the United States? Yes ( ) No ( ) If alien, registration number ___________________________

If naturalized, certificate number ____________________Date______________ Place___________________________

If naturalized, certificate must be attached for verification

2.	Marital Status: Single ( )	Married ( )	Divorced ( ) Widowed ( )

Current Marriage _________________________________________________________________________

Spouse’s Name	Date	City, County, State

Divorce	_________________________________________________________________________

Former Spouse’s Name Date	City, County, State

Spouse Full Name (maiden) ____________________________________ SSN ________________________

Date of Birth _______________________ Place of Birth ________________________________________

Residence Address ________________________________________________________________________

Street	City	State	Zip

Home Phone ( ) _________________________ Business Phone ( ) ___________________________

Spouse’s Employer __________________________________Occupation_____________________________

Address of Employer _________________________________________________________________________

Street	City	State	Zip

3.	Military Information: Have you ever served in any armed forces?

Yes ( ) No ( ) If yes, provide details below.

Branch ___________________________________________ Date of entry-active service_________________

Date of Separation __________________________________Type of Discharge_________________________

Rating at Separation_________________________________ Serial Number____________________________

While in the military service, were you ever arrested for an offense, which resulted in summary action, a trial,

or special general court martial?

Yes ( ) No ( ) If yes, furnish details on a separate sheet.

4.	Arrest, Detention, and Criminal Litigation: (Include those arrests for which you were not convicted)

Have you ever been arrested, detained, charged, indicted, or summoned to answer for any criminal offense

or violation for any reason whatsoever, regardless of the disposition of the event? (Except for minor

traffic citations)

Yes ( ) No ( ) If yes, give details in space below. List ALL cases without exception.

Date Age Charge City, State Disposition Arresting Agency

________________________________________________________________________________________________

________________________________________________________________________________________________

__________________________________________________________________________________________________

________________________________________________________________________________________________

* If you answer “Yes” to any of the following questions (B-F), provide complete details on a separate sheet *

B.	Has a criminal indictment, information, or complaint ever been returned against you, but for which you were not arrested or in which you were named as an un-indicted co-party?

Yes ( ) No ( )

C.	Have you ever been questioned by a city, state, federal, or law enforcement agency, commission or committee?

Yes ( ) No ( )

D.	Have you ever been subpoenaed to appear or testify before a federal, state or county grand jury, board or commission?

Yes ( ) No ( )

E.	Have you ever had a civil or criminal record expunged or sealed by a court order?

Yes ( ) No ( )

F. Have you ever received a pardon for any criminal offense?

Yes ( ) No ( )

G.	Have you, as an individual, ever been named in a lawsuit as either a Plaintiff or Defendant?

Yes ( ) No ( ) If yes, provide details in the space below. List any additional cases on a separate sheet.

Party v. Party Description	Court, Case # and Filing Date	Disposition
Case Summary:

5.	Residences: List all of your residences for the last 10 years. List any additional residences on a separate sheet.

Month/Year-Month/Year	Street & Number	City	State & County

6.	List your education, beginning with high school(s):

Month/Year	School/Location	Degree Earned

7.	Employment: Beginning with your current employment, list your complete work history, including periods of unemployment, for the past 10 years. Also, list all corporations, partnerships, or any other business entities with which you have been associated as an officer, director, stockholder, or similar capacity. Use a separate sheet, if necessary.

Month/Year	Name/Mailing Address of Employer/Business	Reason for Leaving

Title	Description of Duties	Supervisor	Gaming Present? Yes ( ) No ( )

Month/Year	Name/Mailing Address of Employer/Business	Reason for Leaving

Title	Description of Duties	Supervisor Gaming Present? Yes ( ) No ( )

Month/Year	Name/Mailing Address of Employer/Business	Reason for Leaving

Title	Description of Duties	Supervisor	Gaming Present? Yes ( ) No ( )

Month/Year	Name/Mailing Address of Employer/Business	Reason for Leaving

Title	Description of Duties	Supervisor	Gaming Present? Yes ( ) No ( )

8.	Have you ever held a financial interest in a gambling venture, including a race track, dog track, race horse or dog,

lottery, casino, bookmaking operation, or pari-mutuel?

Yes ( ) No ( ) If yes, provide details below and on a separate sheet, if necessary.

Name/Description of Venture	Location	Dates of Involvement

9.	Have you ever been granted a junket permit or gaming license or been a participant in any group which has been issued a junket or gaming license?

Yes ( ) No ( ) If yes, provide details below, and on a separate sheet, if necessary.

Provide a copy of the license or permit.

Type	Location	Dates	Status

10.	Have you or any group with which you have been associated ever been refused a gaming license, permit, or related findings of suitability?

Yes ( ) No ( ) If yes, provide details on a separate sheet.

11.	Have you or any group with which you have been associated ever had a gaming license, permit or related findings of suitability denied, revoked, withdrawn, or issued with special conditions?

Yes ( ) No ( ) If yes, provide details on a separate sheet.

12.	Have you ever owned, operated, or managed any business, company, enterprise or currently own stock, hold interest (other than mutual funds, 401k’s, etc) or currently operate, manage or act as agent for any business, company, enterprise other than the business, company, enterprise for which you are currently applying for a Junket Representative Permit. This should include any “Doing Business as” or “Fictitious Business” names used.

Name of Business	Location	Position (Agent, Owner, Manager etc.)

13.	List any privilege or professional licenses you have held or currently hold, including but not limited to the following:

Driver’s License

Real Estate Broker or Salesman	Liquor/Alcohol

Attorney	Accountant/CPA

Race Horse/Race Dog Owner	Doctor

Trainer or Manager	Boxing Promoter

Jockey	Securities Dealer/Broker/Financial Adviser

Type	Location	Dates	Status

14.	Have any disciplinary actions of any nature, regardless of disposition, ever been initiated against you or a related business entity in relation to any privilege or professional licenses?

Yes ( ) No ( ) If yes, provide details on a separate sheet.

15.	Have any disciplinary actions not otherwise included in question 14 ever been initiated against you or a related business entity?

Yes ( ) No ( ) If yes, provide details on a separate sheet

16.	Do you have any relatives associated with or employed in the gaming industry in any state? Yes ( ) No ( )

If yes, write their name, relation, and association or employment in the space below:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

17.	Do you now or have you ever knowingly been associated with, socially or professionally, persons known to be convicted of a felony or having ties with organized crime? Yes ( ) No ( ) If yes, provide details in the space below and on a separate sheet, if necessary.

_________________________________________________________________________________________________

18.	If currently or previously employed in Mississippi Gaming, give dates and places of issuance of work permits.

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

19.	List any secondary representatives that you intend to employ if your permit is granted.

Name	Address	Tax ID

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Attach a recent photograph taken within the past thirty (30) days here.

MISSISSIPPI GAMING COMMISSION

P.O. BOX 23577

JACKSON, MISSISSIPPI 39225-3577

APPLICATION FOR JUNKET REPRESENTATIVE

STATEMENT OF TRUTH

(To be completed in the presence of a Notary Public)

State of ___________________________________

County____________________________________

____________________________________________________________________, being duly sworn according to law deposes and says:

Name of Applicant

Place your initials in the appropriate response for each statement below:

1. I am the applicant who is submitting this application form.	Yes ( ) No ( )

2. I personally supplied the information contained in this form.	Yes ( ) No ( )

3. I swear (or affirm) that the information contained in this form

is true to the best of my knowledge and belief.	Yes ( ) No ( )

Date: _____________________________ ________________________________________________

(Legal Signature of Applicant)

Subscribed and sworn to before

me on this, the __________________ day of_______________________________	, 20_____.

_________________________________________	_____________________________________

Notary Public	State

SCHEDULE A-CASH IN BANKS

Using the following table, list all accounts maintained by you, your spouse, and your dependents with any financial institutions, foreign and domestic. This includes, but is not limited to checking, savings, time deposits, money market, certificates of deposit, etc.

Name and Address of Bank	Name of Account Holder(s)	Account Type/Number	Date Opened	Balance as of ____/____/____

SCHEDULE B-ACCOUNTS/NOTES RECEIVABLE

Using the following table, list all debts, loans, notes or other receivables owed to you, your spouse, and your dependents.

Name and Address of Debtor	Date Incurred	Original Amount	Current Balance	Payment/Period	Interest Rate	Maturity Date	Purpose & Collateral

SCHEDULE C-STOCKS AND BONDS

Using the following table, list all stocks, bonds, mutual funds, commodity accounts, options, warrants, securities, etc., held or controlled by you, your spouse, and your dependents in any jurisdiction. Individual holdings of mutual funds need not be listed as long as the mutual fund itself is listed. Indicate publicly traded securities with an asterisk (*).

Issuer	Type of Security	Number of Shares	Name of Owner	Date of Purchase	Purchase Price	Current Market Value as of ____/____/____

SCHEDULE D-BUSINESS INVESTMENTS

List below any business investments in which any direct, indirect, vested, or contingent interest is held by you, your spouse, and dependents, along with the names of all individuals or entities who share a direct, indirect, vested or contingent interest therein. This includes, but is not limited to joint ventures, partnerships, sole proprietorships, and corporations.

Name of Entity	Type of Entity	Number of Shares/Units	Percent of Ownership	Name of Owner	Purchase Price and Date of Purchase	Current Market Value as of ____/____/____	Name of Individuals/Entities Sharing Interest and Percentage Owned

SCHEDULE E-REAL ESTATE

List below any real property in which any direct, indirect, vested, or contingent interest is held by you, your spouse, and dependents, along with the names of all individuals or entities who share a direct, vested, or contingent interest therein.

Address/Location	Description	Percent of Ownership	Other Owners	Purchase Price/Improvements at Cost	Date of Purchase	Market Income	Current Market Value as of ____/____/____

SCHEDULE F-OTHER ASSETS

List all other assets held by you, your spouse, and dependents. Use an asterisk (*) in the first column to indicate those held by your spouse or dependents. Other assets includes, but is not limited to automobiles, personal property, cash value life insurance policies, pension plans, IRA, 401(k), etc.

Type of Asset	Date of Purchase	Purchase Price	Current Market Value as of ____/____/____	Description

SCHEDULE G-NOTES/ACCOUNTS PAYABLE

List all notes or accounts payable for which you, your spouse, and dependents are obligated. Use an asterisk (*) in the first column to indicate those held by your spouse or dependents.

Name and Address of Creditor	Date Incurred	Original Amount	Current Balance	Payment/Period	Interest Rate	Maturity Date	Purpose & Collateral

SCHEDULE H-MORTGAGES PAYABLE

List all mortgages or liens payable on real estate for which you, your spouse, and dependents are obligated. Use an asterisk (*) in the first column to indicate those held by your spouse or dependents.

Name and Address of Creditor	Date Incurred	Original Amount	Current Balance	Payment/Period	Interest Rate	Maturity Date	Description of Collateral

SCHEDULE I-CONTINGENT LIABILITIES

List all contingent liabilities for which you, your spouse, and dependents are obligated. Use an asterisk (*) in the first column to indicate those held by your spouse or dependents. Include any other persons liable for each debt, besides you and your spouse, in the description section.

Name and Address of Creditor	Date Incurred	Original Amount	Current Balance	Payment/Period	Interest Rate	Maturity Date	Description

SCHEDULE J-OTHER LIABILITIES

List all other indebtedness for which you, your spouse, and dependents are obligated. Use an asterisk (*) in the first column to indicate those held by your spouse or dependents.

Name and Address of Creditor	Date Incurred	Original Amount	Current Balance	Payment/Period	Interest Rate	Maturity Date	Description of Collateral

* Fill out Schedules A-J on pages 12-21 before completing Statement of Assets and Statement of Liabilities. You must also include any assets/liabilities/accounts held in trust, by or for the benefit of you, your spouse, and your dependents. *

STATEMENT OF ASSETS

AS OF _____________________________, 20________

List all assets, both tangible and intangible on the appropriate line below. Enter the amount as of the date of this statement. Each listed asset must be described fully and all supporting documentation, along with a copy be provided to the investigator assigned to your investigation at the time of your interview.

Original Cost/Investment	Market Value
Current Assets:
Cash on Hand	$___________________	$___________________
Cash in Banks (Schedule A)	___________________	___________________
Accounts & Notes Receivable (Schedule B)	___________________	___________________
Investments:
Stocks & Bonds (Schedule C)	___________________	___________________
Business Investments (Schedule D)	___________________	___________________
Fixed Assets:
Real Estate (Schedule E)	___________________	___________________
Other Assets (Schedule F)	___________________	___________________
TOTAL ASSETS:	$ ___________________	$ ___________________

STATEMENT OF LIABILITIES

AS OF_______________________, 20_________

List all liabilities on the appropriate line below. Enter the amount as of the date of this statement. Each liability must be described fully and all supporting documentation, along with a copy, be provided to the investigator assigned to your investigation at the time of your interview.

Original Amount	Current Balance
Current Liabilities:
Debts Due within One Year………...	$___________________	$___________________
Accounts Payable (Credit Cards, etc.)	___________________	___________________
Taxes Payable………….………….….	___________________	___________________
Long Term Liabilities:
Debts Due in Over One Year………..	___________________	___________________
Notes Payable (Schedule G)………....	___________________	___________________
Mortgages Payable (Schedule H)…....	___________________	___________________
Contingent Liabilities (Schedule I)….	___________________	___________________
Other Liabilities (Schedule J)………..	___________________	___________________
TOTAL LIABILITIES:	$___________________	$___________________
NET WORTH:	$___________________	$___________________
CONTINGENT LIABILITIES (Schedule J):	$___________________	$___________________

RELEASE OF ALL CLAIMS

The undersigned has filed with the Gaming Commission an "application," as that term is defined in the Mississippi Gaming Control Act

and the Gaming Commission. In consideration of the assurance by the Commission that no vote on said "application" will be taken

except after a deliberate, intensive and thorough investigation of the undersigned, including but not limited to background, associates,

and finances, the undersigned does for myself, my heirs, executors, administrators, successors and assigns, hereby release, remise, and

forever discharge the State of Mississippi, the Gaming Commission, its members, agents, and employees, from all and all manner of

actions, causes of action, suits, debts, judgments, executions, claims and demands whatsoever, know or unknown, in law or equity,

which the undersigned ever had, now has, may have, or claim to have against any or all of said entities or individuals arising out of or

by reason of the processing or investigation of or other action relating to the undersigned's "application".

I, the undersigned, have read this release and understand all its terms. I execute it voluntarily and with full knowledge

In witness whereof, I have executed this release at __________________________________________________________________________

City

______________________________________________________, on the_______________________________________________

day of_____________________________________________, 20_____________________.

_____________________________________

Applicant Signature

Subscribed and sworn to before me the _______________________day of

_______________________________________, 20_________________.

____________________________________________________________

Signature

Notary Public in and for the County of_____________________________.

State of____________________________________________.	____________________________________________

Notary Public

APPLICANTS REQUEST TO RELEASE INFORMATION

TO ________________________________________________________________________________

FROM _____________________________________________________________________________

I hereby authorize and request all persons to whom this request is presented having information relating to or concerning me to furnish such information to permit a duly appointed agent of the Gaming Commission, whether or not such information would otherwise be protected from the disclosure by any constitutional, statutory or common law privilege.

I hereby authorize and request all persons to whom this request is presented having documents relating to or concerning me to permit a duly appointed agent of the Gaming Commission, whether or not such information would otherwise be protected from the disclosure by any constitutional, statutory or common law privilege.

If the person to whom this request is presented is a brokerage firm, bank, saving and loan, or other financial institution or an officer of same, I hereby authorize and request that a duly appointed agent of the Gaming Commission be permitted to review and obtain copies of any and all documents, records, or correspondence pertaining to me, including Deposit box records, passbook records, and general ledger folio sheets.

I do hereby make, constitute, and appoint any duly appointed agent of the Gaming Commission my true and lawful attorney in fact for me in my name, place, stead, and on my behalf and for my use and benefit: (a) To request, review, copy, sign for, or otherwise act for investigative purposes with respect to documents and information in the possession of the person to whom this request is presented as I might; (b) To name the person or entity to whom this request is presented and insert that person’s name in the appropriate location on this request; (c) To place the name of the Gaming Commission agent presenting this request in the appropriate location on this form.

I grant to said attorney in fact full power and authority to do, take, and perform all and every act and thing whatsoever requisite, proper, or necessary to be done, in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as I might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that said attorney in fact, or his substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted.

This power of attorney ends eighteen (18) months from the date of execution.

I have filed with the Gaming Commission an “application” as that term is defined in the Mississippi Gaming Control Act, Section 75-76-1, et. Seq. of the Mississippi Code. I understand that I am seeking the granting a privilege and acknowledge that the burden of providing my qualifications for a favorable determination is at all times on me. I accept any risk of adverse public notice, embarrassment, criticism, or other actions of financial loss, which may result from action with respect to this application.

I do, for myself, my heirs, executors, administrators, successors and assigns, hereby release, remise, and forever discharge the person to whom this request is presented, and his agents and employees from all manner of actions, equity, which I ever had, now have, may have, or claims to have against the person to whom this request is presented or his agents or employees arising out of or by reason of complying with this request.

I agree to indemnify and hold harmless the person to whom this request is presented and his agents and employees from and against all claims, damages, losses, and expense, including reasonable attorney’s fees arising out of or by reason of complying with this request.

A reproduction of this request by the Xerox or similar process shall be for all intents and purposes as valid as the original.

In witness whereof, I have executed this request at ________________________________________________________________

On the ___________ day of _________________________, 20_______.

Applicant’s Signature

Subscribed and sworn to before me on this _______________________________ day of __________________, 20 __________.

Notary Public in and for the County of __________________________________. State of _____________________________________.

Notary Public

Signature of Mississippi Gaming Commission agent presenting this request____________________________________________________

Date _______________________________

IRREVOCABLE APPOINTMENT OF AGREEMENT

The undersigned, for the purpose and consideration of, acting as a junket representative, for the Mississippi gaming licensee and does enabling such licensee or licensees with who the undersigned does business to comply with the gaming laws and regulations of Mississippi, does hereby:

Irrevocable appoint the Secretary of State of Mississippi as an agent upon whom process and any all papers to the undersigned may be served for any and all matters arising under the Mississippi Gaming Control Act, the regulations of the Mississippi Gaming Commission and all judicial or legislative proceedings; the undersigned acknowledges that service of any and all papers, pleadings or process made upon the Secretary of State shall have the same force and effect as thought the undersigned had been personally served within the boundaries of the State of Mississippi and that service upon the undersigned had been personally served within the boundaries of the State of Mississippi and that service upon the undersigned shall be deemed completed upon mailing by the Secretary of State of copies of said papers, pleadings or process served upon him, certified mail postage prepaid, to the below designated address.

___________________________________________________________.

(Name of Representative)

Doing business as_________________________________________________________________________________________.

(Name of Business)

at_______________________________________________,	_______________________________________________

(Street)	(City or Town)

The appointment shall remain in full force and effect as long as the undersigned is governed by and subjects to the previsions of the Mississippi Gaming Control Act.

INSTRUCTIONS REGARDING IRS FORM 4506 – T

For your convenience, a fillable form and instructions for Form 4506T can be found at: http://www.irs.gov/pub/irs-pdf/f4506t.pdf Due to revisions being made by the IRS, please use the site to fill out and print the most current form.

Fill out lines 1a through line 4.

On line 5 enter: Mississippi Gaming Commission

Investigations Division

P.O. Box 23577

Jackson, MS 39225-3577

Phone: 601-576-3801

On line 6 enter 1040, 1065, or 1120 for each return form you have filed. This may require you to make multiple copies, one for each return form.

Check box on line 6c.

On line 9 enter the dates of the last four available years of taxes filed.

Sign and date the form at the bottom according to the instructions on form 4506T and mail according to the instructions that accompany the Transcript request.