<p> NEW JERSEY DIVISION OF GAMING ENFORCEMENT TECHNICAL SERVICE BUREAU</p><p>PRINTER FIRMWARE SUBMISSION FORM</p><p>Received:______</p><p>File No:______Lab Use Only</p><p>Submitted By: ______Printer Manufactured By: ______</p><p>Emergency? Yes _____ No _____ If YES, attach Deficiency Report </p><p>Does a Hardware Submission accompany this Submission? Yes _____ No _____ N/A _____</p><p>Manufacturer ID # Version/Date Chip Type Onboard Position Checksum/CRC/Hash*</p><p>* No Kobetron Signature</p><p>For each product listed, provide the following?</p><p>Hardware needed to test the listed product: Printer ID: Printer Kit: </p><p>Is software and hardware necessary to download to printer included with submission?</p><p>Yes _____ No _____ (previously submitted)</p><p>Slot Machine Platforms and Main Programs used to test this product:</p><p>PLATFORMS MAIN PROGRAMS 1 2 3 4 5</p><p>Voucher/Coupon Systems used to test this product:</p><p>VERSION IGT EZ Pay Bally SDS</p><p>1 4/7/2018 NJDGE-PRINTER FIRMWARE SUBMISSION FORM</p><p>ACSC</p><p>Modification of (List Firmware): Lab File No.: </p><p>Reason(s) for this Modification:</p><p>Replacement? Yes _____ No _____</p><p>If YES, list product being replaced and provide reason(s) for replacement:</p><p>List Product ID and Lab File No. to be revoked: Product ID: Lab File No.: </p><p>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.</p><p>Authorized Signature Title Date</p><p>PRINT NAME </p><p>2 4/7/2018</p>