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Get Department Of Public Safety. Exemption Application - Pxw1 Snb

, rue Argyle C. P. 6000 Fredericton, N-B E3B 5H1 78-9752 (2/10) APPLICATION FOR RENEWAL OF REGISTRATION AS A VIDEO LOTTERY SITEHOLDER Name and Address of Registered Video Lottery Siteholder Legal Name Business Name (Operating As) Address (Street Number and Name) (Suite / Floor) (City) (Province / State / Country) (Postal Code / Zip Code) If leasing or renting the facility provide name and address of the landlord. Telephone ( ) Facsimile ( ) Please complete sections below. Section A.

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