(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. (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. (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. (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. (1) the name, title, phone number and email address of a person to be contacted in reference to the application;
2. (2) the current and former d/b/a or trade names used by the entity;
3. (3) the principal business address of the entity;
4. (4) the date and place of formation and information concerning each person forming the entity;
5. (5) all other names under which the entity has conducted business and the approximate time periods during which such names were used;
6. (6) all other addresses presently used by the entity and all addresses from which the entity is presently doing business;
7. (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. (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:

   1. (i) competitive conditions in the industry or industries involved and the competitive position of the entity, if known;
   2. (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;
   3. (iii) the sources and availability of raw materials essential to the business of the entity;
   4. (iv) the importance to the business and the duration and effect of, all material patents, trademarks, licenses, franchises and concessions held; and
   5. (v) a description of any material changes in the business entity’s mode of conducting the business;
9. (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. (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. (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. (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. (13) a description of all bonus, profit sharing, pension, retirement, deferred compensation and similar plans in existence;
14. (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. (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. (16) a description of the nature, type, terms, covenants, conditions and priorities of all outstanding debt and security devices utilized by the entity;
17. (17) a description of each person or entity holding any outstanding debt and security devices the entity uses;
18. (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. (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:

    1. (i) the name and address of the financial institution;
    2. (ii) the type of account;
    3. (iii) the account number; and
    4. (iv) the dates held;
20. (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. (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. (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:

    1. (i) any arrest, indictment, charge or conviction for any criminal or disorderly persons offense;
    2. (ii) any criminal proceeding in which such person has been named a party or an unindicted co-conspirator;
    3. (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;
    4. (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
    5. (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. (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. (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. (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. (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. (27) a description of whether, during the last 10 years, the entity, its parent, any subsidiary or related entity or individual has:

    1. (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;
    2. (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
    3. (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. (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. (29) a copy of the following:

    1. (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;
    2. (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;
    3. (iii) annual reports to shareholders for the last five years;
    4. (iv) any annual reports prepared within the last five years on Form 10K pursuant to the Securities Exchange Act of 1934;
    5. (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;
    6. (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;
    7. (vii) each press release issued by the entity for the past five years;
    8. (viii) last definitive proxy or information statement filed pursuant to the section 14 of the Securities Exchange Act of 1934;
    9. (ix) registration statements filed in the last five years pursuant to the Securities Act of 1933; and
    10. (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. (30) the name, address, and telephone number of the current outside auditor or auditors;
31. (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. (32) a current ownership organizational chart of the entity, its parent entity and each subsidiary of the entity;
33. (33) a functional table of organization for the filing entity, including position descriptions and the names of persons holding such positions;
34. (34) a copy of all Federal Internal Revenue Service tax returns filed by the entity in the last five years;
35. (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. (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. (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. (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. (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. (2) current photograph;
3. (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. (4) any ownership interest, financial interest or financial investment in any business entity applying to or presently licensed by the commission;

5. (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:

   1. (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;
   2. (ii) held a foreign bank account or has had authority to control disbursements from a foreign bank account;
   3. (iii) maintained a bank account, or other account, whether domestic or foreign, that is not reflected on the books or records of the business;
   4. (iv) maintained a domestic or foreign numbered bank account or other bank account in a name other than the name of the business;
   5. (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;
   6. (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
   7. (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. (6) copies of Federal and State tax returns and related information for the last five years, including:

   1. (i) United States Internal Revenue Service forms 1040, 1040X and related schedules;
   2. (ii) an audit narrative or failure to file narrative; and
   3. (iii) foreign tax returns and schedules;
7. (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. (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. (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. (10) a consent to inspection, searches and seizures and the supplying of handwriting exemplars;
11. (11) a notification and authorization form for employment credit report; and
12. (12) a signed, dated and notarized affidavit of truth.