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Minnesota Lawful Gambling LG215 Lease for Lawful Gambling Activity 8{05 Page 1 of 2 Organization name Ucense number Daytime phone North Suburban Youth Foundation 01485 651-638-4600 Name of leased premises Slreet address City I State Zip Daytime phone Big Ten Supper Club 4703 N. Highway 10 Arden Hills !\IN 55112 651-633-7253 Name of legal owner of premises Business/street address City State Zip Daytime phone JohnJ. Welsh I 4748 Cumberland Shoreview MN 55125 651.777-9020 Name of lessor (ifsame as legal Business/street address City State Zip Daytime phone owner, write in "SAME") Same Check all activities that will be conducted: ~ull.tabs _Pull.tabs w~h dispensing device II TIpboards ~paddlewheel __Yaddlewheel with table _Bingo ~Bar bingo Pull-tab, Tipboard, and Paddlewheel Rent (No lease required for raffles,) Booth operation ~ sales of gambling equipment by an employee Bar operation - sales of . gambling equipment within a leased (or volunteer) of a licensed organization within a separate endosure premises by an employee of the lessor from a common area where tflat is distinct from areas where food and beverages are sold. food and beverages are also sotd. r------------------------------------i Does your organization OR any other organization conduct gambling from a booth operation at this location? X Yes No L______________________~__==_________~ If you answered yes to the question above, rent limits are If you answered no to the question above, rent limits are based on the foUowing combinations of operation: based on the following combinations of operation: - Booth operation - Bar operation - Booth operation and pull-tab dispensing device - Bar operation with pull-tab dispensing device . Booth operation and bar operation - Pull-tab dispensing device only - Booth operation, bar operation, and pull-tab dispensing device The maximum rent allowed may not exceed $1,750 in total The maximum rent allowed may not exceed $2,500 in total per month for all organizations at this premises. per month for all organizations at this premises. Complete one option: Complete one option: Option A: o to 10% of the gross profits per month. Option A: 0 to 20% of the gross profits per month. Percentage to be paid % Percentage to be paid % 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 $400 per month may be paid. Amount to be paid $~_. to $200 per month may be paid. Amount to be paid $ Option C: $0 to $400 per month may be paid on the first $4,000 Option C: $0 to $200 per month may be paid on the first $1,000 of gross profit. Amount to be paid $ 400 Plus 0% to of gross profits. Amount to be paid $ Plus 0% to 10% of the gross profits may be paid per month on gross profits 20% of the gross profits may be paid per month on gross profrts over$4,000. Percentage to be paid 10 % over $1,000. Percentage to be paid % Bingo Rent Bar Bingo Rent Option D: 0 to 10% of the gross profits per month from all lawful L Option F: No rent may be paid for bingo gambling activities held during bingo occasions, excluding bar bingo. conducted in a bar. Percentage to be paid % Option E: A rate based on a cost per square foot not to exceed 110% of a comparable cost per square foot for leased space, as approved by the director of the Gambling Control Board. No rent may be paid for bar r------------, for any new bingo activity not previously bingo. Rate to be paid $ per square foot. I induded in a Premises Penn~Application, I The lessor must attadl documentation, verified by the organization, to confinn. the comparable rate and all appliGlblerosts to be paid by the I attach a separate sheet of paper listing the I organization to the lessor. days and hours that bingo will be conducted. L____________.J Amended If this is an amended lease showing changes occurring during the tenn of the current premises pennit, both parties that signed the lease must inilial and date all manges_ Changes must be submitted to the Gambling Control Board Lease at least 10 days prior to the change. Wnte in the date that the manges will be effective ----.J ----.J_. Only Lessor Date Organization Date . . .