U.S. Department of Justice Washington, D.C. 20530
Office of Enforcement Operations, Criminal Division
Attention: Mr. Frederick D. Hess (Director)
Month_________Day_________Year_____
Dear Director F.D. Hess,
My company, ______________________, primarily dealing with amusement equipment, would like to expand our business to include the sale and export various forms of gaming equipment. In consultation with our Legal Advisors we find that we must apply with your good offices to secure permission from the U.S. Department of Justice to transport and export gaming devices.
This letter is a formal request for permission for myself _____________________d.b.a., ____________________, to engage in the export of various forms of gaming devices as per the Gambling Devices Act of 1962 ( 15 U.S.C. 1171, et seq. ). for the calendar year of 1996.
1) Registrant's name: _________________ d.b.a.
Company name: ____________________
President: ________________________
Vice President:_______________________
Sec. / Treas: __________________________
2) Address of Place of Business/s:_____________________
_________________________
3) Address records can be viewed: Same as Above / Other_________________________
4) Activities engaged in: Manufacturing, repairing, reconditioning, buying, selling, leasing, using, and making gambling devices available for use by others and selling, shipping, receiving or delivering gambling devices with the knowledge that these devices will be shipped in interstate or foreign commerce.
We respectfully request your documentation covering the record keeping necessary to comply with the U.S. Department of Justice regulations and will act accordingly. Thank you for your time and hoped for approval of our application.

Sincerely,
Name________________________
Title_______________
________________
_________________