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MINNESOTA I.AWFUL GAMBLING <br />LG23O Application to Conduct Off-Site Gambling <br />6/15 Page 1 of 2 <br />No Fee <br />ORGANIZATION INFORMATION <br />Organizatio n Name: Merrick, Inc.License Number: 00264 <br />Address 3210 Labore Road City Vadnais Heiqhts MN Zip 551 10 <br />Chief Executive Officer (CEO) Name:lohn W. Barker Daytime Phone:651-789-6200 <br />Gambling Manager Name Wendy L. Busch Daytime Phone 651-238-6871 <br />GAMBLING ACTIVIW <br />Twelve off-site events are allowed each calendar year not to exceed a total of 36 days. <br />From 4 t t9 I 20 to __1J_19J_20_ <br />Check the type of games that will be conducted: <br />Raffle Pull-Tabs Bingo pboards Paddlewheel{ <br />GAMBLING PREMISES <br />Name of location where gambling activity will be conducted: Flahertys Arden Bowl <br />Street address and <br />City (or township):1273 West County Road E, Arden Hills Zip: 55tL2 County:r Do not use a post office box. <br />o If no street address, write in road designations (example: 3 miles east of Hwy. 63 on County Road 42). <br />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 ACTMTY (a lease agreement is not required for raffles) <br />Rent to be paid for the leased area: $ 0 (if none, write "0") <br />All obligations and agreements between the organization and the lessor are listed below or attached. <br />o Any attachments must be dated and signed by both the lessor and lessee. <br />o This lease and any attachments is the total and only agreement between the lessor and the organization conducting lawful <br />gambling activities. <br />o Other terms, if any: <br />Lessor's Signature <br />Print Lessor's Name <br />CONTINUE TO PAGE 2 <br />Dater