N.Y. Comp. Codes R. & Regs. Tit. 9 § 5301.2 - Application forms
(a) The
commission shall investigate the background of any applicant for a gaming
facility license, which may include the background of any qualifier, using the
following forms:
(1) a gaming facility
license application form, as prescribed in subdivision (b) of this section, for
each of the applicants, any direct and indirect parent entity of the applicant
(including any holding company), any manager, any entity having a beneficial or
proprietary interest of five percent or more in an applicant or a manager, and
any other entity that may be designated by the Gaming Facility Location Board
or the commission;
(2) a
multi-jurisdictional personal history disclosure form, as promulgated by the
International Association of Gaming Regulators as of the date of the adoption
of this section, for each natural person who is a director, manager, general
partner or person holding an equivalent position with the applicant, a manager
or any direct or indirect parent entity of the applicant, a casino key
employee, a person having beneficial or proprietary interest of five percent or
more in an applicant or a manager and any other person that may be designated
by the Gaming Facility Location Board or the commission; and
(3) a multi-jurisdictional personal history
disclosure supplemental form, as prescribed in subdivision (c) of this section,
for those aforementioned parties submitting a multi-jurisdictional personal
history disclosure form.
(b)
Gaming facility license
application form. A gaming facility license application form shall
require the applicant to provide the following information and such additional
information as the commission may in its discretion determine:
(1) the name, title, phone number and email
address of a person to be contacted in reference to the application;
(2) the current and former d/b/a or trade
names used by the entity;
(3) the
principal business address of the entity;
(4) the date and place of formation and
information concerning each person forming the entity;
(5) all other names under which the entity
has conducted business and the approximate time periods during which such names
were used;
(6) all other addresses
presently used by the entity and all addresses from which the entity is
presently doing business;
(7) all
addresses, other than those listed in paragraph (6) of this subdivision, that
the entity held, or from which it was conducting business during the last
10-year period, and the approximate time periods during which such addresses
were held;
(8) a description of the
business conducted and intended to be conducted by the entity and its parent,
holding, subsidiary and intermediary entities and the general development of
such business during the past five years, or such shorter period as the entity
or its parent, holding, subsidiary and intermediary entities may have been
engaged in business. The description shall include information on the
following:
(i) competitive conditions in the
industry or industries involved and the competitive position of the entity, if
known;
(ii) the principal products
produced and services rendered by the entity and its parent, intermediary and
subsidiary entities, the principal markets for said products or services and
the methods of distribution;
(iii)
the sources and availability of raw materials essential to the business of the
entity;
(iv) the importance to the
business and the duration and effect of, all material patents, trademarks,
licenses, franchises and concessions held; and
(v) a description of any material changes in
the business entity's mode of conducting the business;
(9) a description of any former business, not
listed in response to paragraph (8) of this subdivision, that the 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, indicating the
approximate time period during which each such business was
conducted;
(10) personal
information, including but not limited to, the name, home and work addresses
and date of birth of each director, trustee, and officer of the entity for the
last 10 years. 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 entity's governing
documents;
(11) the annual
compensation of directors, trustees and officers of the entity and whether such
compensation is in the form of salary, wages, commissions, fees, stock options,
bonuses or otherwise;
(12) the
name, business address, date of birth, and position of each person other than a
director, trustee or officer, who receives annual compensation from the entity
of more than $250,000 and the length of time employed and the amount of
compensation;
(13) a description of
all bonus, profit sharing, pension, retirement, deferred compensation and
similar plans in existence;
(14) a
description of the nature, type, number of authorized and issued shares, terms,
conditions, rights and privileges of all classes of voting, non-voting and
other stock issued, or to be issued, or other similar indicia of ownership by
the entity including the number of shares of each class of stock authorized or
to be authorized and the number of shares of each class of stock outstanding,
not held by or on behalf of the issuer, or other similar information applicable
to other indicia of ownership as of this date;
(15) the name, home address and date of birth
of each shareholder of the entity, the class held, number of shares held and
the percentage of outstanding voting or non-voting securities or other
ownership interest held;
(16) a
description of the nature, type, terms, covenants, conditions and priorities of
all outstanding debt and security devices utilized by the entity;
(17) a description of each person or entity
holding any outstanding debt and security devices the entity uses;
(18) a description of any options existing or
to be created with respect to securities issued by the entity in 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;
(19) the following information for each
account for the last 10 years held in the name of the entity or its nominee or
otherwise under the direct or indirect control of the entity:
(i) the name and address of the financial
institution;
(ii) the type of
account;
(iii) the account number;
and
(iv) the dates held;
(20) the name and address of all
persons with whom the entity has contracts or agreements of $250,000 in value
or more including employment contracts of more than one year duration, or who
have supplied goods and services within the last six months and the nature of
such contracts or the goods and services performed;
(21) information in regard to any transaction
within the last five years involving a change in the beneficial ownership of
the entity's equity securities on the part of any current or former director,
officer or beneficial owner of more than 10 percent of any class of equity
security;
(22) a description of any
civil, criminal, administrative and investigatory proceedings in any
jurisdiction for the entity and each director, trustee or officer as follows:
(i) any arrest, indictment, charge or
conviction for any criminal or disorderly persons offense;
(ii) any criminal proceeding in which such
person has been named a party or an unindicted co-conspirator;
(iii) any civil litigation that exists or
that existed within the previous five years to which the entity, its parent or
any subsidiary is, or was, a party, if damages exceeded $100,000, or are
reasonably expected to exceed $100,000, unless such damages involved or
involve, claims against the entity that were, or are, fully and completely
covered under an insurance policy;
(iv) any judgment order, consent decree or
consent order entered against the entity pertaining to a violation or alleged
violation of the Federal antitrust, trade regulation or securities laws or
similar laws of any jurisdiction; and
(v) any judgment order, consent decree or
consent order pertaining to any State or Federal statute, regulation or code
that resulted in a fine or penalty of $50,000 or more within the past 10
years;
(23) for the
entity, parent or any intermediary entity, information in regard to any
judgments or petitions for bankruptcy or insolvency and any relief sought under
any provision of the Federal bankruptcy code or any State insolvency law; and
information in regard to any receiver, fiscal agent, reorganization trustee or
similar officer appointed for the property or business of the entity or its
parent, holding, intermediary or subsidiaries;
(24) a description of whether, during the
last 10 years, the entity has had any license or certificate issued by any
governmental agency denied, suspended or revoked;
(25) a description of whether, during the
last 10 years, the 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-mutuel operation, lottery, sports betting, etc.);
(26) a description of whether, during the
last 10 years, the entity its parent or any subsidiary, director, officer or
employee or any third party acting on behalf of the entity made any bribes or
kickbacks or made any payments alleged to have been bribes or kickbacks to any
employee, company, organization, government official, domestic or foreign, to
obtain favorable treatment;
(27) a
description of whether, during the last 10 years, the entity, its parent, any
subsidiary or related entity or individual has:
(i) donated or loaned property or anything of
value for the purpose of opposing or supporting any government, political
party, candidate, or committee, either foreign or domestic;
(ii) made any loans, donations or other
disbursements to its directors, officers or employees for the purpose of
reimbursing such individuals for political contributions, either foreign or
domestic; and
(iii) maintained a
bank account or other account, domestic or foreign, not reflected on the books
of the entity, or maintained any account in the name of the nominee of the
entity;
(28) the names
and addresses of any of the entity's current or former directors, officers,
employees or third parties who would have knowledge or information concerning
subparagraph (27)(iii) of this subdivision;
(29) a copy of the following:
(i) audited financial statements for the last
fiscal year, including, without limitation, an income statement, balance sheet
and statement of sources and application of funds, and all notes to such
statements and related financial schedules;
(ii) all annual financial statements prepared
in the last five years, any exceptions taken to such statements by the
independent auditor retained by the entity and the management response
thereto;
(iii) annual reports to
shareholders for the last five years;
(iv) any annual reports prepared within the
last five years on Form 10K pursuant to the Securities Exchange Act of
1934;
(v) the last quarterly
unaudited financial statements prepared by or for the entity, which, if the
entity is registered with the United States Securities and Exchange Commission,
may be satisfied by providing a copy of the most recently filed 10Q;
(vi) any current report prepared due to a
change in control of the entity, acquisition or disposition of assets,
bankruptcy or receivership proceedings, changes in the entities certifying
accountant, or other material events, which, if the entity is registered with
the United States Securities and Exchange Commission, may be satisfied by
providing a copy of the most recently filed form 8K;
(vii) each press release issued by the entity
for the past five years;
(viii)
last definitive proxy or information statement filed pursuant to the section 14
of the Securities Exchange Act of 1934;
(ix) registration statements filed in the
last five years pursuant to the Securities Act of 1933; and
(x) all reports and correspondence submitted
in the last five years by independent auditors for the entity that pertain to
the issuance of financial statements, managerial advisory services, or internal
control recommendations;
(30) the name, address, and telephone number
of the current outside auditor or auditors;
(31) a certified copy of the articles of
incorporation, charter and by-laws and all amendments proposed thereto or other
formation documents, if the entity is not a corporation;
(32) a current ownership organizational chart
of the entity, its parent entity and each subsidiary of the entity;
(33) a functional table of organization for
the filing entity, including position descriptions and the names of persons
holding such positions;
(34) a copy
of all Federal Internal Revenue Service tax returns filed by the entity in the
last five years;
(35) a release
authorization (dated and signed by the president or any officer of the entity
authorized to affirm and sign the document) directing all courts, probation
departments, selective service boards, employers, educational institutions,
banks, financial institutions and all governmental agencies, Federal, State and
local, both foreign and domestic, to release any and all information pertaining
to the entity as required by the commission and its authorized agents and
representatives;
(36) a waiver of
liability (dated and signed by the president or any officer of the entity
authorized to affirm and sign the document) as to the State of New York and its
instrumentalities and agents for any damages resulting from any disclosure or
publication of any material or information acquired during the licensing or
investigation process;
(37) a
consent (dated and signed by the president or any officer of the entity
authorized to affirm and sign the document) to inspections, searches and
seizures and the supplying of handwriting exemplars; and
(38) a signed, dated and notarized affidavit
of truth in a form provided by the commission (dated and signed by the
president or any officer of the entity authorized to affirm and sign the
document).
(c)
Multi-jurisdictional personal history disclosure supplemental
form. A multi-jurisdictional personal history disclosure form shall
require the applicant to provide the following information and such additional
information as the commission may in its discretion require:
(1) name and nature of position with or
interest in a gaming facility license applicant or licensee, a vendor
enterprise applicant or licensee, or a holding company, as
applicable;
(2) current
photograph;
(3) citizenship, and if
applicable, resident alien status, including any certificate of naturalization,
United States Citizenship and Immigration Services documentation, employment
authorization with expiration date, country of which the applicant is a
citizen, place of birth, proof of entry to the United States and name of
address of sponsor upon arrival;
(4) any ownership interest, financial
interest or financial investment in any business entity applying to or
presently licensed by the commission;
(5) a disclosure of whether, during the last
10 years, any entity in which he or she had been a director, officer or
principal employee or a holder of five percent or greater interest has:
(i) made or been charged with, either itself
or through third parties acting for it, bribes or kickbacks to any government
official, domestic or foreign, to obtain favorable treatment or to any company,
employee or organization to obtain a competitive advantage;
(ii) held a foreign bank account or has had
authority to control disbursements from a foreign bank account;
(iii) maintained a bank account, or other
account, whether domestic or foreign, that is not reflected on the books or
records of the business;
(iv)
maintained a domestic or foreign numbered bank account or other bank account in
a name other than the name of the business;
(v) donated or loaned corporate funds or
corporate property for the use or benefit of, or for the purpose of opposing,
any government, political party, candidate or committee either domestic or
foreign;
(vi) compensated any of
its directors, officers or employees for time and expenses incurred in
performing services for the benefit of or in opposition to any government or
political party domestic or foreign; and
(vii) made any loans, donations or other
disbursements to its directors, officers or employees for the purpose of making
political contributions or reimbursing such individuals for political
contributions whether domestic or foreign;
(6) copies of Federal and State tax returns
and related information for the last five years, including:
(i) United States Internal Revenue Service
forms 1040, 1040X and related schedules;
(ii) an audit narrative or failure to file
narrative; and
(iii) foreign tax
returns and schedules;
(7) a signed, dated and notarized release
authorization that shall direct all courts, probation departments, selective
service boards, employers, educational institutions, banks, financial and other
institutions and all governmental agencies, Federal, State and local, both
foreign and domestic, to release any and all information pertaining to the
applicant as requested by the commission, the Gaming Facility Location Board or
any employee, agent or representative thereof;
(8) the name, address, occupation, phone
number, email address and years known of persons who can attest to the good
character and reputation of the applicant;
(9) a waiver of liability as to the State of
New York and its instrumentalities and agents for any damages resulting from
any disclosure or publication of material or information acquired during the
licensing process, or during any inquiries, investigations or
hearings;
(10) a consent to
inspection, searches and seizures and the supplying of handwriting
exemplars;
(11) a notification and
authorization form for employment credit report; and
(12) a signed, dated and notarized affidavit
of truth.
Notes
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