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Devin De'Wan Carter EX-1371 11091-2023

Create: Wed, 01/10/2024 - 16:12

Author: rmcgarvey

Devin De'Wan

Carter

EX-1371

11091-2023

Wed, 11/15/2023 - 10:10

Devin_DeWan_Carter.pdf600.08 KB

PENNSYLVANIA

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NAME OF INDIVIDUAL FILING A DISPUTE OR COMPLAINT

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LAST NAME:

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HOME ADDRESS:

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PHONE NUMBER:

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DATE AND APPROX TIME OF INCIDENT:

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Please provide a summary of the incident or dispute to the best of your knowledge. Include any statements which you made to the licensed gaming entity's personnel or any statements you made to witnesses to the incident or dispute.

Please provide a summary of the incident or dispute to the best of your knowledge. Include any statements which you made to the licensed gaming entity's personnel or any statements you made to witnesses to the incident or dispute.

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