Fill and Sign the Florida Gaming Corp Security Offering and Investment Secreport Form

NON -FOREIGN AFFIDAVIT UNDER INTERNAL REVENUE CODE SECTION 1445(b)(2) STATE OF KENTUCKY ) COUNTY OF _________________) I/WE, ______________________________________________________________________, the "Seller(s)", being first duly sworn, state under penalties of perjury: 1. That I/WE am/are the Transferor(s) of the property located at _____ _____________________________________________________________ , in the City of ____________________________, County of _________________, State of Kentucky, and described as follows: District ___________ Section ___________ Block ___________, Township __ ____, Range ________ or Parcel Number ___________________________________ 2. That my/our United States taxpayer identification number is/are: Seller: _____________________________ Tax ID: _________________________ Address: __________________________ _________________________________ City ________________ State_______ Zip__________ Seller: _____________________________ Tax ID: _________________________ Address: ___________________________________________________________ City ________________ State_ ______ Zip_________ Seller: _____________________________ Tax ID: _________________________ Address: ___________________________________________________________ City ________________ State_______ Zip_________ Seller: _____________________________ Tax ID: _________________________ Address: ___________________________________________________________ City ________________ State_______ Zip__________ 3. That I/WE am/are not a "foreign person" as that term is def ined in Section 1445(f) of theInternal Revenue Code. This affidavit is given to ___________________________________________________, the "transferee(s) or Buyer(s)" of the property described in paragraph 1 above for the purpose of establishing and docume nting the non -foreign affidavit exemption to the withholding requirement of Section 1445 of the Internal Revenue Code. ___________________________________________________ _______________________________________________ Seller Date Seller Date ___________________________________________________ _______________________________________________ Seller Date Seller Date Sworn to and Subscribed before me this the _________ day of __________________, 20______. My Commission Expires: _______________________________________ NOTARY PUBLIC ________________________