Please write all card names completely and legibly.
Judge Use Only: M S E
Please include the quantity for each card.
Last Initial
Full Name: Date: M M / D D / Y Y Y Y
Main Deck Total
Konami Player ID: Event: 40
Monster Cards Spell Cards Trap Cards
2 Ash Blossom & Joyous Spring 1 Foolish Burial 1 Tearlaments Metanoise
2 Beastking of the Swamps 1 Foolish Burial Goods 1 Tearlaments Sulliek
1 Danger! Mothman! 1 Pressured Planet Wraitsoth 1 Trivikarma
2 Danger! Nessie! 1 Primeval Planet Perlereino
1 Destiny HERO - Denier 2 Tearlaments Grief
2 Destiny HERO - Malicious 1 Tearlaments Heartbeat
1 Destrudo the Lost Dragon's Frisson 3 Tearlaments Scream
2 Gameciel, the Sea Turtle Kaiju 1 Triple Tactics Talent
1 Kashtira Fenrir 2 Triple Tactics Thrust
1 Keldo the Sacred Protector
1 Mudora the Sword Oracle
1 Shaddoll Beast
1 Tearlaments Havnis
1 Tearlaments Kashtira
3 Tearlaments Reinoheart
2 Tearlaments Scheiren
24 <<< Total Monster Cards 13 <<< Total Spell Cards 3 <<< Total Trap Cards
Side Deck Extra Deck For Judge Use Only
1 Baronne de Fleur Deck List Checked?
1 Beatrice, Lady of the Eternal Judge Initial Infraction(s):
Description:
1 Black Rose Dragon
1 Cross-Sheep
1 Destiny HERO - Dangerous Deck Check Rd:
1 Dharc the Dark Charmer, Gloomy Judge Initial Infraction(s):
Description:
1 El Shaddoll Winda
1 Garura, Wings of Resonant Life
1 Grapha, Dragon Overlord of Dark World Deck Check Rd:
1 Mudragon of the Swamp Judge Initial Infraction(s):
Description:
1 Predaplant Dragostapelia
1 Tearlaments Kaleido-Heart
1 Tearlaments Kitkallos
1 Tearlaments Rulkallos
1 Time Thief Redoer
0 <<< Total in Side Deck 15 <<< Total in Extra Deck
