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State of California Use Only State of California Gambling Control Commission CCC 037 (New 09-06Rev. 04/08) Date Received: Data Input Date: Date to CCC: SELF-EXCLUSION FORM Type or print (in ink) all.

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How to fill out the CA CGCC-037 online

The CA CGCC-037 is a self-exclusion form for individuals wishing to limit their access to gambling establishments in California. This guide will provide you with clear, step-by-step instructions on how to accurately complete this form online.

Follow the steps to complete the CA CGCC-037 form online effectively.

  1. Click the ‘Get Form’ button to obtain the CA CGCC-037 and open it in your desired online format.
  2. Begin by filling out Section 1, Personal Information. Enter your full legal name including first, middle (if applicable), and last name. Include any other names such as former names, nicknames, or aliases.
  3. Provide your home address, including street, city, state, and zip code. If your mailing address differs from your home address, enter that information as well.
  4. Next, fill in your home telephone number and business number, if applicable. Indicate the games you most often play.
  5. In Section 2, Term of Exclusion, select the appropriate duration of your exclusion by initialing next to your choice: One Year, Five Years, or Lifetime.
  6. Proceed to Section 3, where you will provide personal identifiers. Enter your height, weight, date of birth, race or ethnicity, hair color/type, and eye color. Affix a recent passport-quality photograph showing your head and shoulders.
  7. Describe any distinguishing marks such as scars or tattoos, including their locations. Additionally, specify the type of vehicle you normally drive and its license plate number.
  8. In Section 4, Declaration, review the statements provided. Initial the required fields to acknowledge your understanding of the terms, including your voluntary request for exclusion and agreement to not enter gambling establishments during the designated period.
  9. Make sure to sign and date the form in the appropriate spaces, asserting that all information is truthful and complete.
  10. Section 5 includes Notarization. Have the form notarized if required, or complete the witness section by having a key employee affirm your completion of the form.
  11. Finally, save your changes to the form. You may choose to download, print, or share the completed CA CGCC-037 as needed.

Begin completing the CA CGCC-037 online today to ensure your self-exclusion request is handled properly.

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CA CGCC-037
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