Laserfiche WebLink
<br />Minnesota Lawful Gambling <br /> <br />Lease for Pull-Tab, Paddlewheel, Ti <br /> <br />Name of Legal Owner of Premises Street Addreaa <br /> <br />oldie K Siedow 3873 114thLn.N.E. <br />Name of Lessor Street Address <br />(If same as legal owner. write In "SAME") <br /> <br />Pot 0' Gold 3776 Connell Ave. <br />Name of Leased Premises Street Address <br />3776 Co elly Ave, <br /> <br />Name of Lessee (name of organization ieasing the premises) <br />Earthstar project, Inc. <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 />~~\lM-- C <br /> <br />board, and/or Raffle Activi <br />City Zip Daytime Phone <br />Blaine MN 55449 (612) 783 1840 <br />City Zip Daytime Phone <br />612 783-1840 <br />(651 )6311724 <br />Daytime Phone <br />( 651 ) 631-1724 <br />Deytime Phone <br />( 651 ) H~:de9:r <br /> <br />y'2- <br />- LG221 <br /> <br />Arden Hills MN <br />City <br />Arden Hills MN <br /> <br />55112 <br />Zip <br />55112 <br /> <br />GCB license no. of organization <br />A-04711 <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 $ 0 <br />(If no rent is to be paid. indicate 4-) <br /> <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 ieased areas are: <br /> <br /> <br />Storage <br />Storage <br /> <br /> <br />Lawful Gambling Activity <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br /> <br />,.-,';." <br /> <br />Paddlewheels <br /> <br />. X Pull-Tabs <br /> <br />Term of Lease <br /> <br />The term of this lease agreement will be concurrent with <br />the premises permit issued by the Gambling Control <br />Board, unless terminated sooner by mutual consent of <br />the lessor and lessee. <br /> <br />: .\;.~..; ~"1 <br />.~~~~~:- <br /> <br />_Raffles _ Tlpboards <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_'_. Both parties that signed the lease <br />must initial and date all changes. ',j. <br />...:.: <br /> <br />Questions 6ri 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 \Ising a TrY may call the Minnesota Relay Service <br />at. 1-80P;S27 -3529 and ask to place a call to 651-639-4000. <br />. ,," <br /> <br />.,,~.....).. <br />.....,;.,.::.:..,: >.:'. <br />. ~~",i.mt 1", <br /> <br />The information requested on this form will become public" <br />Information when received by the Board. and will be used to. J <br />determine your compliance with Minnesota statutes and rules <br />goveming lawful gambling activities. . <br /> <br />Page 1 of2 <br />1/99 <br />