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Giovanni Gallipoli EX-658 5039-2016

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

Author: admin

Giovanni

Gallipoli

EX-658

5039-2016

Tue, 03/21/2017 - 20:00

Giovanni_Gallipoli.pdf111.54 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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