Chalmette Amusement Company

Southeast Louisiana’s Premier Coin-Op Amusement & Video Gaming Company

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Video Poker Licensing Forms

New Applicants

  • Application (DPSSP 0031) & Instructions
  • Release of all Claims (DPSSP 0035)
  • Request to Release Information (DPSSP 0037)
  • Affidavit of Full Disclosure (DPSSP 0036)
  • Personal History Questionnaire (DPSSP 0032)
  • Personal Financial Questionnaire (DPSSP 0033)

Renewal Applicants

  • Renewal Application (DPSSP 0049) & Instructions
  • Individual Consent to Disclosure of Tax Information (Federal & State)
  • Company Consent to Disclosure of Tax Information (Federal & State)
  • Renewal Affidavit/Certification (DPSSP 0051)

Miscellaneous Poker Forms

  • Annual Licensee Form (DPSSP 6643)
  • Licensee Application Affidavit/Certification (DPSSP 0051A)
  • Stock Transfer
  • Multiple Use Reporting Form (DPSSP 6600)

Please contact us if you need help with any of these forms.

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Link to Title 42 Red Book
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