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<br />Minnesota Lawful Gambling <br />'Lease for Pull-Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 <br /> <br />/\ <br />l.~_ \ <br /> <br />Name of Legal Owner of Premises Street Address City Slate Zip Daytime Phone <br />John 1. Welsch 2058 Jefferson St. Paul MN 55705 651-699-7235 <br />Name of Lessor Street Address Cily Slate Zip Daytime Phone <br />(If same as legal "",ner, wr~e in "SAME") <br />SAME <br />Name of Leased Premises Street Address C~y Zip Daytime Phone <br />Big Ten Supper Club 4703 N. Highway 10 Arden Hills 55112 651- 633-7253 <br />Name af Lessee (name of organization leasing the premises) GeB license no. of organization Daytime Phone <br />North Suburban Youth Foundation 01485 65 1- 638-4600 <br /> <br />e <br /> <br />Rent Information <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 "",t is to be pad. indicate-o-) <br /> <br />1,000 <br /> <br /> Dimensions 6 8 <br />. The leased areas are: feet by feet for a total of <br /> feet by feet for a total of <br /> feet by feet for a total of <br /> Storage feet by feet for a total of <br /> Storage feet by feet for a total of <br /> Combined total <br /> Lawful Gambling Activity <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 />For Premises Penn it Renewal Applications Only: If no <br />changes have been made at the site, you do not have to <br />complete this section or provide a sketch. <br /> <br />48 sq uare feet. <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />48 square feet <br /> <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br /> <br />~ Paddlewheels !KJ Pull-Tabs ~ Raffles [!] Tipboards <br />Term of Lease Amended Lease Only <br /> <br />The term of this lease agreement will be concurrent <br />with the premises permit issued by the Gambling Control <br />Board. unless terminated sooner by mutual consent of <br />the lessor and lessee. <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 />--.J --.J_. Both parties that signed the lease <br />must initial and date all changes. <br /> <br />Questions on this form should be directed to the Licensing <br />Section of the Gambling Control Board (Board) at 651-639- <br />.000. This publication will be made available in alternative <br />ormal (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 />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 <br />governing lawful gambling activities. <br /> <br />Page 1 of 2 <br />1/99 <br />