Printer Firmware Submission

NEW JERSEY DIVISION OF GAMING ENFORCEMENT TECHNICAL SERVICE BUREAU

PRINTER FIRMWARE SUBMISSION FORM

Received:______

File No:______Lab Use Only

Submitted By: ______Printer Manufactured By: ______

Emergency? Yes _____ No _____ If YES, attach Deficiency Report

Does a Hardware Submission accompany this Submission? Yes _____ No _____ N/A _____

Manufacturer ID # Version/Date Chip Type Onboard Position Checksum/CRC/Hash*

* No Kobetron Signature

For each product listed, provide the following?

Hardware needed to test the listed product: Printer ID: Printer Kit:

Is software and hardware necessary to download to printer included with submission?

Yes _____ No _____ (previously submitted)

Slot Machine Platforms and Main Programs used to test this product:

PLATFORMS MAIN PROGRAMS 1 2 3 4 5

Voucher/Coupon Systems used to test this product:

VERSION IGT EZ Pay Bally SDS

1 4/7/2018 NJDGE-PRINTER FIRMWARE SUBMISSION FORM

Modification of (List Firmware): Lab File No.:

Reason(s) for this Modification:

Replacement? Yes _____ No _____

If YES, list product being replaced and provide reason(s) for replacement:

List Product ID and Lab File No. to be revoked: Product ID: Lab File No.:

Test results and documentation for each new product included? Yes _____ No _____ CERTIFICATION (To be completed by the engineer performing the testing) I hereby certify that the information and representations made in this Checklist and in the attachments hereto, are true, accurate and complete. I understand that if any of the statements, data or information contained herein are willfully false, I am subject to punishment. I further understand that if the information contained herein is inaccurate, for any reason, the company is subject to a civil penalty to be imposed by the New Jersey Division of Gaming Enforcement.

Authorized Signature Title Date

PRINT NAME

2 4/7/2018