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<br />Minnesota Lawful Gambling <br /> <br />Lease for Pull-Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 <br />Name of Legal Owner of Premises Street Address City Zip Daytime Phone <br />John J. Welsch 2058 Jefferson St. Paul 55705 (651) 699-7235 <br />Name of Lessor Street Address City Zip Daytime Phone <br />(If same a.legal owner, write in "SAME") <br />John J. Welsch 2058 Jefferson <br /> <br />Name of Leased Premises Street Address <br />Big Ten Supper Club 4703 N. Highway 10 <br />Name of Lessee (name of organization leasing the premises) <br />North Suburban Youth Foundation <br /> <br />Rent Information <br /> <br /> <br />St. Paul <br /> <br />55705 <br /> <br />(651 )699-7235 <br /> <br />Daytime Phone <br />(651 )633-7253 <br />Daytime Phone <br />(651 ) 638-4600 <br /> <br />City <br />Arden Hills <br /> <br />Zip <br />55112 <br /> <br />GCB license no. of organization <br />01485 <br /> <br />. Total rent cannot exceed $1,000 per month for all <br />non-bingo activity for this premises. <br /> <br />. For bingo activity, use lease form LG222.' <br /> <br />. For pull-tab dispensing machines, use lease form <br />LG223. . <br /> <br />. An organization may not pay rent to itself or to <br />any of its affiliates for space used for the conduct <br />of lawful gambling. <br /> <br />Rent to be paid per month $ <br />(If no rent is to be paid, indicale..o-) <br /> <br />1,000.00 <br /> <br />~ . '. . <br /> <br />feet by feet for a total of <br />feet by 8 feet for a total of <br />feet by feet for a total of <br />feet by feet for a total of <br />feet by feet for a total of <br /> Combined total <br /> <br />Sketch and Dimensions of Leased Area <br /> <br />Sketch: For all areas being leased for the conduct <br />of gambling and storage of gambling product at this <br />premises, attach a sketch (drawing) showing: (1) the <br />leased area(s). and (2) the dimensions. <br /> <br />Dimensions <br />The leased areas are: <br /> <br />6 <br /> <br />Storage <br />Storage <br /> <br />."). <br /> <br /> <br />48 <br /> <br />square feet <br />square feet. <br />square feet. <br />square feet <br />square feet. <br />square feet. <br /> <br />. <br /> <br />4W <br /> <br />Lawful Gambling Activity <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br /> <br />..x..-- Paddlewheels <br /> <br />Term of Lease <br />The term of this lease agreement will be concurrent with <br />the premises permit Issued by the Gambling Control <br />Board, unless terminated soone(bv,mutual consent of <br />the lessor and lessee. ~~ <br /> <br />L\' 00 - 11' 02. - ~ <br /> <br />X-Pull-Tabs <br /> <br /> <br />Ouestlons on this form should be directed to the Licensing <br />Section of the Gambling Control Board (Board) at 651-639- <br />4000. This publication will be made available in alternative <br />format (i.e. large print, Braille) upon request. Hearing impaired <br />individuals using a TTY may call the Minnesota Relay Service <br />at 1-800-627 -3529 and ask to place a call to 651-639-4000. <br /> <br />X--Raffles X--Tipboards <br /> <br />Amended Lease Only <br /> <br />If this is an amended lease showing changes occur- <br />ring during the term of the current premises permit, <br />write in the date that the changes will be effective <br />---1---1_. Both parties that signed the lease <br />must initial and date all changes. . <br /> <br />The information requested on this form will become public <br />information when received by the Board, and will be used to <br />determine your compliance with Minnesota statutes and rules a <br />governing lawful gambling activities. ., <br />Page 1 of2 <br />1/99 <br />