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<br />e <br /> <br />. <br /> <br />. <br /> <br />\' r.....j j('\, /' t"\ <br />,,_ l ,'" f-.-jl'),\ J,.~ 'i '-'f <br />J ~........;,-,",,:j ,........L,........: ~ <br /> <br />Minnesota Lawful Gambling <br /> <br />Lease for Pull-Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 <br /> <br />Name of Legal Owner of Premises Street Address City State Zip Daytime Phone <br /> <br />G-olJ.~ l'-l~ L" L 111> ,><;~l{1 7r .i!l{o <br />Name of Lessor Street Address City State Zip Daytime Phone <br />(If same as legal owner, write in "SAME") <br /> <br />Name of Leased Premises <br /> <br />Street Address <br /> <br />City <br /> <br />Zip <br /> <br />Daytime Phone <br /> <br /> <br />Rent Information <br />. <br />. Total rent cannot exceed $1,000 per month for all <br />non-bingo activity for this premises. <br /> <br />. For bingo activity, use lease form LG222. <br /> <br />. For pull-tab dispensing machines, use lease form <br />LG223. <br /> <br />f/).J5S/lL ell.171. <br />Daytime Ph",e <br />to{ f$' .f('1' <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, indicate -0-) <br /> <br />o <br /> <br />feet by feet for a total of . square feet. <br />feet by feet for a total of square feet. <br />feet by feet for a total of square feet. <br />feet by feet for a total of square feet. <br />feet by feet for a total of square feet. <br /> Combined total square feet. <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 />Storage <br />Storage <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 />Lawful Gambling Activity <br /> <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br /> <br />o Paddlewheels Pull-Tabs 0 Raffles 0 Tipboards <br /> <br />Term of Lease Amended Lease Only <br /> <br />The term of this lease agreement will be concurrent with If this is an amended lease shOlNing changes occur- <br />the premises permit issued by the Gambling Control ring during the term of the current premises permit, <br />Board, unless terminated sooner by mutual consent of write in the date that the changes will be effective <br />the lessor and lessee. --1--1----C.. 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 />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 651-6394000. <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 compiiance wllh Minnesota statutes and rules <br />governing lawful gambling activities. <br /> <br />Page 1 of 2 <br />1/99 <br />