Video Poker Licensing Forms

New Applicants

• Video Gaming 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)
• Individual Consent to Disclosure Tax Information (Federal & State)
• Business, Trust, Estates, Etc. Consent to Disclosure Tax Information (Federal & State)
• Video Poker Associated Business Entity Form DPSSP 6504 (R 01/2014)
• License/Renewal Affidavit Certification (DPSSP 0051)

Renewal Applicants

• Annual License Form (DPSSP 6643)

Miscellaneous Poker Forms

• Stock Transfer Application Checklist
• Multiple Use Reporting Form (DPSSP 6600)
• Gaming Device Ownership Transfer Notification (DPSSP 0052)
• Video Draw Poker Employee Permit Application with Instructions (DPSSP 6503)

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