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Frank George Dellisanti EX-005 1635-2010

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

Author: admin

Frank George

Dellisanti

EX-005

1635-2010

Wed, 12/15/2010 - 19:00

frank_dellisanti.pdf58 KB

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NAME OF INDIVIDUAL FILING A DISPUTE OR COMPLAINT

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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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USER/SCREEN NAME USED:

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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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