New Jersey Administrative Code
Title 13 - LAW AND PUBLIC SAFETY
Chapter 69A - APPLICATIONS
Subchapter 5 - FORMS
Section 13:69A-5.5A - Qualifier Resubmission Form-Casino Qualifiers

Universal Citation: NJ Admin Code 13:69A-5.5A

Current through Register Vol. 56, No. 18, September 16, 2024

(a) A Qualifier Resubmission Form shall be in a format prescribed by the Division and may require the applicant to provide the following information:

1. Name, including maiden name and any aliases or nicknames;

2. Date of birth;

3. Physical description;

4. Current address and residence history;

5. Social Security number, or the reason why the applicant does not have that number, which information shall be utilized solely for tax administration as provided under 42 U.S.C. § 405(c)(2)(C)(i) and N.J.S.A. 54:50-25 and for child support enforcement as provided under 42 U.S.C. § 666(a)(13) and N.J.S.A. 2A:17-56.60;

6. Citizenship, and, if applicable, resident alien status, including any employment authorization and expiration date;

7. The casino licensee or applicant, or holding company, as applicable, with which the applicant is associated, and the nature of the applicant's position with or interest in such entity;

8. Telephone number at home and at current place of employment;

9. Employment history since last submission; and

10. Financial data, as follows:
i. All assets and liabilities of the applicant and the applicant's spouse and dependent children, as indicated on the net worth statement and supporting schedules in a format prescribed by the Division, including cash, bank accounts, notes payable and receivable, real estate and income taxes payable, loans, accounts payable and any other indebtedness, contingent liabilities, securities, real estate interests, real estate mortgages and liens, life insurance, pension funds, vehicles and other assets;

ii. Additional information regarding bank accounts and safe deposit boxes; and

iii. Copies of Federal tax returns and related information.

(b) A Qualifier Resubmission Form may also require an applicant to provide the following information for the time period since the submission of his or her most recent disclosure form:

1. Judgments or petitions for bankruptcy or insolvency concerning the applicant or any business entity in which the applicant held a five percent or greater interest, other than a publicly traded corporation, or in which the applicant served as an officer or director;

2. Referral or finder's fees in excess of $ 10,000;

3. Gifts whether tangible or intangible, which either individually or in the aggregate are in excess of $ 10,000 given or received by the applicant or the applicant's immediate family;

4. Ownership interest in any business(es);

5. Government positions and offices presently or previously held, by the applicant or the applicant's spouse and offices, trusteeships, directorships or fiduciary positions presently or previously held with any business entity by the applicant or the applicant's spouse;

6. Trusteeships or other fiduciary positions held by the applicant or the applicant's spouse, and any denial or suspension of, or removal from, such positions;

7. Licenses and other approvals held by or applied for by the applicant or, where specified, the applicant's spouse, in this State or any other jurisdiction, as follows:
i. Any professional or occupational license held by or applied for by the applicant or the applicant's spouse;

ii. Any license, permit, approval or registration required to participate in any lawful gambling operation in this State or any jurisdiction held by or applied for by the applicant; and

iii. Any denial, suspension or revocation by a governmental agency of a license, permit or certification held by or applied for by the applicant or the applicant's spouse, or any entity in which the applicant or the applicant's spouse was a director, officer, partner or an owner of a five percent or greater interest;

8. Civil, criminal and investigatory proceedings in any jurisdiction, as follows:
i. Arrests, charges or convictions for any criminal or disorderly persons offenses committed by the applicant or any member of the applicant's immediate family;

ii. Any instance where the applicant has been named as an unindicted party or co-conspirator in a criminal proceeding or held as a material witness;

iii. Any appearance before, investigation by or request to take a polygraph examination by any governmental agency, court, committee, or grand jury or investigatory body;

iv. Lawsuits to which the applicant was or is a party; and

v. Any citation or charge for a violation of a statute, regulation or code of any jurisdiction, other than a criminal, disorderly persons, petty disorderly persons or motor vehicle violation; and

9. Whether any entity in which the applicant has been a director, officer, principal employee or a holder of five percent or greater interest has:
i. Donated, used or loaned, funds or property for the use or benefit of or in opposing any government, political party, candidate or committee either foreign or domestic;

ii. Compensated its directors, officers or employees for time and expenses incurred in performing services for the benefit of or in opposing any government or political party either foreign or domestic;

iii. Made any loans, donations or other disbursements to its directors, officers or employees for the purpose of making political contributions or reimbursing such individuals for political contributions either foreign or domestic;

iv. Either the applicant or through third parties acting for it made bribes or kickbacks to any government official domestic or foreign, to obtain favorable treatment or to any company, employer or organization to obtain a competitive advantage;

v. Maintained a foreign bank account or had authority to control disbursements from a foreign bank account; and

vi. Maintained a bank account, whether foreign or domestic or other account which is not reflected on the books or records of the business or which is in a name other than the name of the business.

(c) In addition to the information in (a) and (b) above, a completed Qualifier Resubmission Form may include the following:

1. A signed, dated and notarized certification of truth; and

2. A signed, dated and notarized Release Authorization which shall direct all courts, probation departments, selective service boards, employers, educational institutions, banks, financial and other institutions and all governmental agencies, Federal, state and local, without exception, both foreign and domestic, to release any and all information pertaining to the applicant as requested by the Division.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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