Laserfiche WebLink
MINNESOTA LAWFUL GAMBLING 5/13 Page 1 of 2 <br />LG230 Application to Conduct Off-site Gambling No Fee <br />Organization Information <br />Organization name A ecr C k, 1 License number ()0 7U-,q <br />Address 3 Z U L c, boN,- 1 or, cA City Va Jno(_5 j,5.MN Zip code s r <br />County <br />1(L U-5C'A Daytime phoneGamblingmanagernameW <br />Gambling Activity <br />1. Twelve off-site events are allowed each calendar year not to exceed a total of 36 days. <br />from V to 515- <br />2. Check the type of games that will be conducted. <br />raffle pull-tabs bingo tipboards paddlewheel <br />Gambling Premises <br />3. Name of location where gambling activity will be conducted r=11 C. .•" 1 !30t .) j <br />4. County [where gambling activity will be conducted <br />S. Street address and city [or township] , W ( tJ'+'1 a CCS Zip code <br />Do not use a post office box. <br />If no street address, write in road designations. Example: 3 miles east of Hwy 63 on County Road 42. <br />6. Does your organization own the gambling premises? <br />Yes If yes, a lease is not required. <br />No If no, the lease agreement below must be completed, and signed by the lessor. <br />Lease Agreement for Off-site Activity A lease agreement is not required for raffles. <br />7. Rent to be paid for the leased area <br />1/ If <br />If none, write "0." <br />S. All obligations and agreements between the organization and the lessor are listed below or attached. <br />Any attachments must be dated and signed by both the lessor and lessee. <br />This lease and any attachments is the total and only agreement between the lessor and the organization <br />conducting lawful gambling activities. <br />Other terms, if any <br />9. Lessor's signature Date J <br />Print lessor's name <br />CONTINUE TO PAGE 2