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. . . Minnesota Lawful Gambling LG215 Lease for Lawful Gambling Activity 8/05 Page 1 of 2 Organization name ;,-f: r-tt1f(i"{(I.(/E : License number Daytime phone ;j rf.,41rJ;,4N ,J.€1Ho (Joy ~' /fup( If 5 ( (,3 (, '-- Name of leased premises Street address City State Zip Daytime phone i r~r 0 (,:-~tp 4/rJ;;"" H'L(\ M]\' 5,H" l.fr {,j/ t72~ ~4i 6'" , ,rf ftL-L '377<' (~AltJ6"y f</( - Name of legal owner of premises i ~ Business/street address City : State Zip Daytime phone _G-::';LOI ~ V , ~ 1~v..:.>0-" ,>171... C";;'V,/U€Ut .fv~' 1'[',/17<../ if-".-<-S /1,.-(6 ~-rl/ L (rr 'j./ 17 L t./ ----- Name of lessor (If same as legal: Business/street address City , State Zip Daytime phone owner, write in "SAME") ! c;,4 /"l ,". . C!1eck all activities that will be conducted: _Paddlewheel with table -4BingO _Bar bingo Y_ Pull-tabs _Pull-tabs with dispensing device _ Tipboards - Paddlewheel Pull-tab, Tipboard, and Paddlewheel Rent (No lease required for raffles.) Booth operation - sales of gambling equipment by an employee Bar operation - sales of gamhling equirment within a leased (or vOlunteer) of a licensed organization within a separate enclosure premrses by 3:, employee of the lessor from a common area where that is distmct from areClS where food and beverages are solel. food and beverages are also sold. r------------------------------------~ Docs youl" ol"ganization OR any other organization conduct gambling from a booth operation at this tocation? _~ Yes ~ No L~___________________________________~ If you ans'Ncrcd yes to the question abovc, rcnt limits are If you answered no to the question above, rent limits are ) baSed on the foilowing combinations of operation: based on thE' foHowing comblf1ations of operation: Booth operation Booth operation and pull"tab dispensing device Booth operation and bar operation Booth operation, bar operation, and pulHab dispensing device Bar operation Bar operation with pull-tab dispensing device Pull-tab dispenSing deVice only i I' ,. I , I HIe maximum rent allowed may not exceed $1,750 in total per month for all organizations at this premises. I I . I Camp ete one option: Option A: Q to lQCl/o of the gr-oss profits per month. Percentage to be paid % The maximum rent aUowed may not exceed $2,500 in total per month for all orgarll7ations at this premises. Complete one option: Option A: 0 to 20% of the gross profits per month. Percentage to be paid % Option B: When gross profits are $4,000 or less per month, $0 to Option B: When gross profits arc $1,000 or Jess per month, $0 5400 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 of gross profit. Amount to be paid $_____ Plus 0% to 100/0 of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid _ % Option C: $0 to $200 per month may be paid on the first $1,000 of gross profits. Amount to be paid $_____. Plus 0% to 20% of the gross profits may be paid per month on gross profits over $1,000. Percentage to be paid % Bingo Rent Option 0: 0 to 10% of the gross. profits per month from afllawful gambling activities held during bingooccasionsl excluding bar bingo. Percentage to be paid ~ % Bar Bingo Rent _ Option F: No rent may be paid for bingo conductedinabar. Option E: A rate baseo Of1 a cost per square foot not to exceed 1100/0 of a comparable cost per square foot for leased spacE', as approvecl by the director of the Gambling Control Board. No rent may be paid for bor bingo. Rate to be paid $ 1.), u u per square foot. The lessor must attach documentation, verified by the organization, to confirm the comparable rate and all applicable costs to be paid by the organization to the lessor. r - - - ~ - ~ - -- -:- ~--, For any new bingo activity not previously ! included in a Premises Permit AppHcation, t I attach a separate sheet of paper listing the I days and hours that bingo Will be conducted_ L__~.___ _______..J Amended Lease Only It this is an amended lease showing changes occurring during the term of the current premises permit, both parties that signed the lease must initial and date an changes. Changes must be submitted to the Gambling Control Board at least 10 days prior to the change. Write in the date that the changes will be effective ___ / .l_ Lessor Date Organization Date