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. Minnesota Lawful Gambling LG215 Lease for Lawful Gamblin Activi Ciy fldlF A-vd-u..tLs Ciy 8/03 Page 1 oH Name of lege I owner of premises LoA Street address Slate IttJ Zip Daytime phone <J!:/I z.... ts { -t,5{, -<fJ Zip Daytime phone Id."'-" i () W Name of Ie r Street address (If same as legal owner, write in -SAMEj '7 A-HF Name of leased premises Slreetaddress Ciy Zip Daylimephone tf,-GUIV~S t?x:<v+bnti/:l..O(1J) f{J.& ;ftvd(}A4r)./tl hlJ 55il2 cPr:; -h"7t--'fIZ3 Namp: of lessee (organization leasing the premises) Organization license number Daytime phone hi Jd- "Bn ....de.- ;TIAC- t!';J.8''-Ir "~/-&"'3~-/ Rent Information (fur activity involving puil-tabs, tipboar<ls, paddlewheels, and puil-tab dispensing devices. No lease required for raffles.) Booth operation - sa5es d gambUng equIpment by an emp&oyee (or Bar uv-~ ~ sales of gamblng equipment wIhIn it teased volunteer) d a lltensed organization within a separate endosure that Is premises by an ~ of the lessor from a common a~ lI"II1:Bt!: ~~~~~~~~~~~~~~~~----~~~~~~~~~~--------, Does your organization OR _yother organization conduct gambOng fmma___nllt_IoClOllon? ~Yes _No .J L____________________________________ If you answered yes to the question above, rentiimitsare lfyou answered no tothequestion above, rent "mits are based on the foilowing combinations of opemtion: based m the _ng contJjnalionsof ope. aoo.,: Booth operation Bar operation Booth operation and pull-tab dispensing device Bar operation with pull-tab dispensing device Booth operation and bar operatim Pull-tab dispensing device only Booth operation, bar operation, and pul~tab dispensing device Slate The maximum rent allowed may not exceed $1,750 in total per month for ail organizationS at this premises. The maximum rent ailowed may notexceed $2,000 In total per month for ail organizat:iens atthis premiseS. Complete one option: Option A: 0 to 20% of the gross profits per month. Percentage to be paid % . Complete one option: Option A: 0 to 10% of the gross profits per month. Percenlagetobepaid .. 10 % Option B: WIlen gross prolits are $4,000 or less per month, $0 to Option B: When gross profits...e $1,000 or less per month, $OlD $400 per month may be paid. Amount to be paid $ $200 per month may be paid. Amountto be paid $ Option C: $0 to $400 per month may be paid on the first $4,000 of gross profit. Amount lD be paid $ . Plus 0% to 10% Of the gross profits may be paid per month on gross profits over$4,OOO. Percentage to be paid _% Option C: $0 to $200 per month may be paid on the first $1,000 ofgrossproflts. Amounttobepald.$ . PlusO%to 20% of the gross profits may be paid per month on gross profits over$l,ooO. Percentagetobepaid__% Bingo and/or Bar Bingo Ocleasions Rent for bingo and all other gambling activities conduc\ed during a bingo occasion may not exceed: . $200 per occasion for up to 6,000 square feet . $300 per occasion for up to 12,000 square feet . $400 per occasion for more than 12,000 square feet . $25 per occasion for ber bingo conducted at any time in a bar (regardless of square footage). Your organization must conduct another form of lawful gambling, and the premises must serve intoxicating liquor or 3.2 percent malt beverages. Rent to be paid per bingo occasion $ NOTE: If there are any otherterms orconditions for rent-related Oreck aD actiYitiesthatwU be c:ooducted: expenses, they must be identified on page 2 uncler Acl<nowledgment }LPull-tabs _Pull-tabs with dispensing devite of Lease Terms and are su' to Board a I. l1pboarrls Paddl....neel Paddlewheel with table Rent Infonnatlon: Bingo Noon Hour Bingo Occasions Rent may not exceed $25 per day for noon hour bingo conducted between 11 a.m. and 2 p.m. at a premises with a license for the sale of intoxicating beverages on the premises. Rent to be paid per bingo occasion $ . Amended Lease Only r--------------, for....y new bingo activity not previously I included in a Premises Permit App6cation, I I attach a separate.heet of paper listing the I day. and hours that bingo win be conducted. L J If this \San amended lease showing changes occurring dunng the term of the current premises pernit, both parties that signed the lease must initial and date an changes. Changes must be submitted to the Gambling Control Board at lea.t 10 cloys prior to the change. Write in the date that the changes will be effective ---1---1_. Lessor Date Organization Date