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Jihad Abdur-Razzaq EX-196 3118-2013

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

Author: admin

Jihad

Abdur-Razzaq

EX-196

3118-2013

Mon, 01/07/2013 - 19:00

Jihad_Abdur-Razzaq.pdf51.89 KB

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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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Address

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PHONE NUMBER:

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DATE AND APPROX TIME OF INCIDENT:

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Online Site Used*

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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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