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(Casino Name) (Date) REPORT SUSPICIOUS OR ILLEGAL GAMBLING RELATED ACTIVITY ANONYMOUSLY ANONYMOUS TIP LINE PHONE NUMBER: 1-888-314-2682 MGCB-LC-3004 (Rev. 02/13) f-caren.75372 SUBMIT AN ANONYMOUS TIP AT: WWW.MICHIGAN.GOV/MGCB CASINO LICENSE ANNUAL RENEWAL REPORT This form is authorized under Public Act 69 of 1997, the Michigan Gaming Control and Revenue Act. For the purposes of this renewal application, the term "licensee, unles.
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