APPLICANT'S, PRODUCER'S AND AUTHORIZED REPRESENTATIVE'S INFORMATION A. Full Legal Name of Company to receive the tax credit

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Lorraine Mitchell
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1 Please Note: An application for a certificate of eligibility for transferable tax credits must be submitted not earlier than 90 days before the date of commencement of Principal Photography or Principal Development as set forth in the regulations. I APPLICANT'S, PRODUCER'S AND AUTHORIZED REPRESENTATIVE'S INFORMATION A. Full Legal Name of Company to receive the tax credit Company Name: Company Address: State: Zip Code: Phone: Fax: State of Organization: Federal Tax ID Number: Profit Non-Profit Limited Liability Company C Corporation General Partnership Limited Liability Partnership S Corporation Limited Partnership Other: Joint Venture B. PRODUCER'S Nevada Business Address (or Production office): (Registration with the NFO to do business in Nevada MUST occur before beginning the start of production) Producer(s) Name: Nevada Address: State: Nevada Zip Code: C. Full Legal Name of Authorized Representative. (List of authorized persons to discuss this form) Authorized Representative(s): Title: Level of Agency Representation: Term of Agency: Attach a separate sheet for additional producers and/or authorized representatives Page 1 of 5

2 II THE PRODUCTION INFORMATION A. Production Title: B. Production Website: C. Type of Production: D. Projected Production Rating (from MPAA, ESRB, or similar nationally recognized rating association) Rating: Rating Association: E. Name of the Producer(s): F. Name of the Director(s): G. Names of proposed Cast: Attach a separate summary sheet for additional proposed cast Definition per NRS : a QUALIFIED PRODUCTION includes preproduction, production and postproduction and means: a theatrical, direct-to-video or other media motion picture; a made-for-television motion picture; visual effects or digital animation sequences; a television pilot program; interstitial television programming; a television, internet or other media series, including, without limitation, a comedy, drama, miniseries, soap opera, talk show or telenovela; a national or regional commercial or series of commercials; an infomercial; an interstitial advertisement; a music video; a documentary film or series; other visual media productions, including, without limitation, video games and mobile applications. This term does not include news, weather or current events program; a production that is primarily produced for industrial, corporate or institutional use; a telethon or any production that solicits money, other than a production which is produced for national distribution; a political advertisement; a sporting event; a gala or award show; and other type of production that is excluded by regulations adopted by the Office of Economic Development pursuant to NRS Any type of production featuring obscene or sexually explicit material, is not eligible for transferable tax credits NRS (8)(a)(5). D. Certification: I certify that this production meets the above criteria for a Qualified Production. Signed: Date: Page 2 of 5

3 III A. Employment Information: PERSONNEL INFORMATION B. Proposed PAYROLL for Above-the-Line Personnel (ATL): NON-NEVADA (1) Total ATL PAYROLL for NON-NEVADA RESIDENTS: $ (2) Total ATL PAYROLL NON-NV DISALLOWED >$750,000 $ (3) Total ATL PAYROLL DISALLOWED >5% NON-NV PRODUCER $ REMAINING ATL ALLOWABLE PAYROLL NON-NV $ NEVADA (4) Total ATL PAYROLL for NEVADA RESIDENTS: $ (5) Total ATL PAYROLL DISALLOWED >$750,000 $ (6) Total ATL PAYROLL DISALLOWED >10% NV PRODUCER $ REMAINING ATL ALLOWABLE PAYROLL-NV $ C. Proposed PAYROLL for Below-the-Line Personnel (BTL): (1) Total BTL PAYROLL for NON-NEVADA RESIDENTS: $ (2) Total BTL PAYROLL for NEVADA RESIDENTS: $ D. Proposed Number of hires for Below-the-Line Personnel (BTL): (3) Total number of NON-NEVADA RESIDENTS: (4) Total number of NEVADA RESIDENTS: IV (5) Percent Nevada BTL PROJECTED TOTAL BUDGET FOR THE ENTIRE PRODUCTION % (A). Total QUALIFIED EXPENDITURES including Preproduction, (1) Within Nevada $ Production, and Postproduction costs (NRS (1)): (2) Outside Nevada $ (B). Expenditures and Costs That Are Not Eligible (NRS (2)): $ (C). Total Production Costs Incurred: $ (1) Percent Nevada to Total Expense % Page 3 of 5

4 V PROPOSED LOCATIONS AND SCHEDULE (A) Estimated Project Start Date: (B) Estimated Project Completion Date: (C) Nevada Location 1: (D) Nevada Location 2: (E) Nevada Location 3: (F) Nevada Location 4: VI Attachment 1: Attachment 2: Attachment 3: Attachment 4: Attachment 5: Attachment 6: Attachment 7: Attachment 8: Attach a separate summary sheet for additional Nevada Locations. ATTACHMENTS Script, storyboard, or flow chart of the production. Explanation of how the proposed production is in the economic interest of Nevada Detailed budget for the entire production (must be $500,000 or more), which MUST: (1) include separate subtotals for costs incurred within and outside of Nevada, (2) show at least 60% of the total qualified expenditures and production costs will be incurred in Nevada, and (3) include separate subtotals for expenditures and costs that are not eligible to serve as a basis for transferable tax credits as all are set forth in the Nevada Revised Statutes and Regulations. Proposed Capital Investment in real property and other tangible personal property purchased (unless otherwise included above). Proposed jobs summary for the production including without limitation, the: (1) number of jobs created, (2) anticipated term of employment, (3) anticipated wage levels, and (4) proposed fringe benefits for all ATL and BTL who received compensation as part of the production (unless included above). Proof of adequate financing, (a) Fifty percent or more of the funding for the qualified production has been placed in an escrow account or trust account for the benefit of the QUALIFIED PRODUCTION,, or that (b) the PRODUCER has a corporate credit rating of "lower medium grade" or higher from a credit rating agency found suitable by the Office. Limited Power of Attorney authorizing the NFO to receive information on financing Marketing and Distribution plans for the PRODUCTION. Page 4 of 5

5 VII AGREEMENTS AND ACKNOWLEDGEMENTS (A) I certify that the production has, or will, secure all licenses, registrations and other filings required to do business in each proposed production location in Nevada. (B) I agree and acknowledge that the PRODUCER will provide other information within 14 days, as it is required by the OFFICE. (C) I agree and acknowledge that the PRODUCER shall give notice to the Nevada Film Office, 6655 W. Sahara Ave., Ste. C-106, Las Vegas, NV at the start of production. (D) I agree and acknowledge that the PRODUCER will provide to the OFFICE monthly progress reports, with reference to benchmarks, during the PRODUCTION. (E) I agree and acknowledge that the PRODUCER will pay for a final audit by a Nevada independent certified public accountant approved by the OFFICE. This audit will include an itemized report of QUALIFED EXPENDITURES AND PRODUCTION COSTS, and showing at least $500,000 was incurred in Nevada, and submit same to the OFFICE no later than 30 days after completion of the PRODUCTION. (F) I agree and acknowledge that the PRODUCER shall provide a Declaration of Residency, with sufficient evidence, which will be a required part of the audit package for all ATLs or BTLs claimed to have Nevada residency as all are set forth in the regulations. (G) I agree and acknowledge that the producer will repay to the Department or the State Gaming Control Board, as applicable, any portion of the transferable tax credits to which the producer is not entitled if found to have submitted any false statement, representation or certification in any document for the purpose of obtaining Transferable Tax Credits, or who otherwise becomes ineligible for transferable tax credits after receiving the transferable tax credits. (H) I agree and acknowledge that the PRODUCER shall provide proof of insurance certificate, binder or quote for general liability insurance totaling $1,000,000 or more at the start of production. (I) I agree and acknowledge that the PRODUCER shall provide proof that the production meets the applicable requirements relating to worker's compensation insurance at the start of production. (J) I agree and acknowledge that the State of Nevada may withhold, in whole or in part, any portion of the tax credits until any pending legal action in the State against the producer or qualified production is resolved. VIII OATH AND SIGNATURE Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it and all of the attached information are true and correct. Signature OF Authorized Representative Date (mm/dd/yy) Print Name Title form date 1/1/2014 Page 5 of 5

Senate Bill No. 165 Senators Ford, Smith, Denis, Hutchison, Roberson; Atkinson, Jones, Kihuen, Manendo, Parks, Segerblom, Spearman and Woodhouse

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