Skip to main content

PENNSYLVANIA

GAMING CONTROL BOARD

Main navigation

About PGCB
- PGCB Overview
- Leadership
  - Board Members
  - Executive Staff
- Board Meetings
- Organization Reports
- Employment
- Doing Business with PGCB
- Local Law Enforcement Grants
Gaming
- Overview
- Benefits for Pennsylvanians
- Patron Complaint/Dispute Forms
- Compulsive and Problem Gambling
- Maps of Casinos in PA
- Diversity
  - Diversity Compliance Overview
  - Diversity Plans
- Related Links
- Sect. 1512 - List of Public Employees
- Involuntary Exclusion List
Licensing
Gaming Law & Regulations
Office Of Hearings & Appeals
- Calendar
- Filings
News & Transparency
CONTACT US

Translate this page

Search form

Search

Esayas G. Ketema EX-404 4235-2015

Create: Thu, 07/13/2023 - 22:12

Author: admin

Esayas G.

Ketema

EX-404

4235-2015

Tue, 10/20/2015 - 20:00

esayas_ketema.pdf113.55 KB

PENNSYLVANIA

GAMING CONTROL BOARD

PA Gaming Control Board
303 Walnut Street, Commonwealth Tower, 5th Floor
Harrisburg, PA 17101
(717) 346-8300

CONNECT

WITH US

Quick Links

ABOUT US
GAMING & REVENUE
LICENSING INFO & APPLICATIONS
SLOTSLINK
SLOTSLINK HR
GAMING LAW & REGULATIONS
OFFICE OF HEARINGS & APPEALS
NEWS & TRANSPARENCY
EMPLOYMENT OPPORTUNITIES
USE OF PGCB MEETING SPACE
CONTACT US

EMPLOYEE WEB EMAIL | REPORT A WEBSITE ISSUE

PRIVACY POLICY | Copyright © 2024 - PENNSYLVANIA GAMING CONTROL BOARD SITE BY ACUTA DIGITAL

NAME OF INDIVIDUAL FILING A DISPUTE OR COMPLAINT

First Name

First Name?

LAST NAME:

Last Name

Last?

HOME ADDRESS:

Home Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

PHONE NUMBER:

Phone Number

EMAIL ADDRESS:

Email Address

DATE AND APPROX TIME OF INCIDENT:

Incident Date

Incident Date: Date

Incident Date: Time

COMPLAINT TYPE:

Complaint Type (Choose One)

Complaint Number:

Complaint Number

ONLINE SITE USED:

Online Site Used*

DEVICE TYPE:

Device Type

USER/SCREEN NAME USED:

User / Screen Name Used

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.

agreement

understand

ATTACHMENTS or DOCUMENTATION?
While NOT REQUIRED to file a complaint, after completing this form, if you have items (texts, screen shots, emails, etc.) relating to this complaint, you can send them in a separate email. For instructions, please reference the confirmation email that will be sent you once this form is submitted

*For security reasons, only certain file types are allowed.

Attachment

Upload requirements

One file only.
50 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.