List any group, firm, partnership, corporation or any other business entity in which the applicant or any of its owners, officers or directors holds an ownership interest of 10% or more that has filed a gaming related application in any jurisdiction and whose application has been denied, suspended, revoked or withdrawn and explain the circumstances of the disposition.
You must attach a current ownership and management table of organization as well.
List the President, CEO, CFO, COO, and any person routinely performing corresponding functions with respect to an organization whether incorporated or unincorporated, individuals who have a direct or indirect ownership or beneficial interest of 10% or more in the gaming service provider applicant and salespeople or other employees of the applicant who solicit or who will solicit business from or who has or who will have regular contact with a licensee.
*Note* Each individual listed will be required to provide fingerprints to the Board for investigation purposes. A fingerprint package will be sent by the Bureau of Investigations and Enforcement to the residential address supplied for each individual listed once the application is received by the Board. Each individual listed is also required to complete a separate release authorization located in the back of the form. A $60.00 fee is required to be sent with the application for each qualifier listed.
At what percentage of ownership does Pennsylvania require Key Disclosures and who should disclose this information?
Written by Chris Loach
Updated over 2 years ago