EXHIBIT (xii)
SUBSCRIPTION
The undersigned ___________________________________,
pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe
for and purchase ____________ shares of the Common Stock of Mid-State Raceway,
Inc., covered by said Warrant, and makes payment therefor in full at the price
per share provided by said Warrant.
Dated:_________________________ Signature_____________________
Address_______________________
ASSIGNMENT - CAP 4
FOR VALUE RECEIVED, __ALL CAPITAL, LLC hereby sells, assigns
and transfers unto __RACEWAY VENTURES, LLC ______ the foregoing Warrant and all
rights evidenced thereby, and does irrevocably constitute and appoint
________________________ attorney, to transfer said Warrant on the books of
Mid-State Raceway, Inc.
Dated: MARCH 24, 2004 Signature /s/ XXXXX XXXXX
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Address 0000 X. XXXXXXXXX XXX., XXXXX 700
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LAS VEGAS, NEVADA 89119
PARTIAL ASSIGNMENT
FOR VALUE RECEIVED, _______________________ hereby assigns and
transfers unto __________________________ the right to purchase ____________
shares of the Common Stock of Mid-State Raceway, Inc. by the foregoing Warrant,
and a proportionate part of said Warrant and the rights evidenced hereby, and
does irrevocably constitute and appoint ______________________, attorney, to
transfer that part of said Warrant on the books of Mid-State Raceway, Inc.
Dated: _______________________ Signature_______________________
Address_________________________
