Sample Letter Requesting Hearing For Removal Of Name From The Self-Exclusion List printable pdf download

Sample Letter Requesting Hearing For Removal Of Name From The Self-Exclusion List

SAMPLE LETTER REQUESTING HEARING

FOR REMOVAL OF NAME

FROM THE SELF-EXCLUSION LIST

Your Name

Your Return Address

Your Telephone Number

Date

Louisiana Gaming Control Board

Administrative Hearing Office

P. O. Box 4096

Baton Rouge, LA 70821

Dear Docket Clerk:

My name is ___________________________ and, pursuant to LAC 42:III.304(A), I had my

Name placed on the list of persons who are to be excluded or ejected from all casino gaming

Establishments licensed or operating pursuant to Chapters 4, 5, and 7 of the Louisiana Gaming

Control Law, R.S. 27:1 et seq. My inclusion on the List became effective on ___________________

(mm/dd/yy).

More than five years have elapsed since that date and I now desire to have my name removed

from the Self-Exclusion List. Accordingly, I am hereby requesting a hearing before the Board Hearing

Officer to have my name removed from the List. The specific reasons why I wish to be removed from

the Self-Exclusion List are as follows: [List of Reasons].

Pursuant to LAC 42:III.304(G), please find enclosed a written recommendation from (Dr., Mr.,

Ms., etc.) ______________________________, a qualified mental health professional, stating my

capacity to participate in gaming activities without adverse risks or consequences.

Thank you for your assistance with this matter.

Yours truly,

Sample Letter Requesting Hearing For Removal Of Name From The Self-Exclusion List