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["MISSOURI GAMING COMMISSION"]
[]
["Gaming Device Shipping Request"]
["MGCShipping@mgc.dps.mo.gov"]
["Shipping Contact: Heather Berhorst (573) 526-6830  MGC Jefferson City Office"]
["Per Missouri Code of State Regulation (CSR), 11 CSR 45-5.237 (1), this form must be submitted to the Missouri Gaming Commission (MGC) at least (5) days prior to the date of shipment. This request MUST receive MGC approval PRIOR to shipment.  Use a separate form for each destination address. Attach additional pages if necessary. Suppliers may only ship to MGC approved destinations (i.e. Class B licensees, licensed suppliers, or otherwise approved by the Commission). The completed form shall be in the possession of the carrier during the delivery of the listed device(s)."]
["SHIPPER INFORMATION"]
["Shipper's Name: ",null,null,"Date Submitted to MGC:"]
["Shipper's Address:",null,null,"Arrival Date:"]
["License Number:"," ",null,"Carrier:"]
["Contact Name:",null,null,"Ship Date:"]
["Contact Phone #:",null,null,"Amendment (Y/N) / Date:"]
["Email Address:",null,null,"Mode of Transportation:"]
["DESTINATION INFORMATION"]
["Destination Name:",null,null,"RE / Invoice / Sales Order #:"]
["License Number:",null,null,"Total Number Shipped:"]
["Destination Address:"]
["DICE SHIPMENT INFORMATION"]
["Total Number of Dice","Artwork # or Design","Size","# of sets / # dice per set","Color & Finish"]
[]
[]
[]
[]
[]
["CARD SHIPMENT INFORMATION"]
["Total Number of Decks","Artwork # or Design","Card Type ","Packaging (single, 2, 6, or 8 deck)","Color"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["GAMING DEVICE & EQUIPMENT INFORMATION"]
["Description ","Model Number","Serial Number","MGC Tag Number (MGC Use Only)"]

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