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. . . 8{05 Page 1 of 2 Minnesota Lawful Gambling LG215 Lease for Lawful Gambling Activity Organization name License number Daytime phone >t MM:-f f?<>Mj-1./I.4-~&~1HoO"'~ cHuRdl ."'~_n~t 4.rr.:)"'-"f I Nameo!leas doremlses Street address Crty Slale Zip Daytime phone I I \1' I p~-r c (; old kil7"o ---1J7I- C~II~I(<I_k~__J:LdjL___-,,--~,-,-----,-r'--il~~ IName olle~al owner of premises BUSiness/street addr~~ Crty . State Zip Daytime phone I LG-~ 1~L3~~.l1.I<" C"~J1'---~-"'--JtdiL -"YJ ~r{I'-_ --- J Name of lessor (if same as legal Business/street address City State Zip Daytime phone I owner, write In "SAME") SI<Mf'_ Check all activities that will be conducted: __PUll-tabs __ Pull-tabs with dispensing device _Tipboards Paddlewhecl Paddlewheel with table -X-Bingo __Bar blngo Pull-tab, Tipboard, and Paddlewheel Rent (No lease requ"ed for caffles,) Booth operation. Sdles of gambling equipment by an employee (or volunteer) 01 a licensed organilation within a separate 'V"'l!osure that is distinct from areas Wflere food ;:lnd beverages iJre sord. Bar operation soles at gambling equl[)ment within a leased premisl'S by on employee or the lessor frOrTI a common area where toad and beveruge,> are iJlSO sukJ. ------------ -- -------""1 -------' If you answered yes to the qucStlon above, rcnt limits are based on the followtng combinations of operation: Bootll operation Booth operation and pull-tab dispensing device BOOUl operation and bar operation ! _ Booth operation, bar operation, and pull-tab dispensing device If you answered no to the question above, rent limits are based on tlle following combinations of operation. Bar operdtion Bar operation with pull-tab dispensing deVice Puli-tab dispensing device only The maximum rent allowed may not exceed $1,750 in total per month for all organizations at this premises. fhe miJXimum rent allowed may not exceed $2,500 in total per month for all organizations dt this prcmlses. Complete one option: Option A: 0 to 10% of the gross profits per month. Percentage to be paid _ % Complete one option: Option A: 0 to 20% of the gross profits per month. Percentage to bc paid_ _____ U/a Option B: When gross profits are $4,000 or less per month, $0 to Option B: When gross profits are $1,000 or less per month, $0 1 $400 per month may be paid. Amount to be paid $___. to $200 per month may be paid. Amount to be paid t.__. Option C: $0 to $400 per month may be paid on the first $'1,000 uf gross profit. Amount to be paid $_ ~ Plus 0% to 10%, of tile gross profits may be paid per month on gross profits over $4,000 f'ercentage to be paid ___ % Option C: $0 to $200 per rnonnl may be paid on the first $1,000 of gross proflts_ Amount to be paid $__ ___. Plus 0% to 20% of the gross profits may be paid per month on gross profits over $1,000 Pel-cent;-)geto be paid ________% Bingo Rent Option 0: 0 to 10% of the gross profits per rnonth from all lawful gambling activities held during bingo occasions, excluding bar bingo. Percentagc to be paid _ % Bar Bingo Rent _ _ Option F: No rent may be paid for bingo conductl-'d 111 a bar Option E: A rate based on a cost per square foot not to exceed 110% of a comparable cost per squJTe foot for leased spacc, as approved by the director of the Gambling Control Board. No rent may be paid for bar bingo. Rate to be paid $____ per square foot. The lessor must attach documentation, verified by the organization, to confnm the comparClble rate and all applicable costs to be paid by the j orgcmization to the lessor - _.- - - - --- - - - - For any new bingo activity flat previously I included in a Premises Permit Application, I I attach a separate ",Ileet of paper listing the I days and hours that bingo ,"'-1111 be com1ucted L_____ ___________.J Amended Lease Only Jf thiS is an amended lease shov...ing changes occurnng dunn<:J the term of Ule current pr-emlse5 permit, both parties that signed the lease rnustlnitial and date all changes. Changes rnust be submitted to the Gambling Control Board at least 10 days prior to the change Nnte In the date that the changes Will be effectlVf' j ----- --.l_______ Lessor Date Organl1ation D,Jte , --.- ~---_._-_._._--_._-_..._-_._---_..__..-