05-29-07 Item 4B, Resolution 07-56 Chartiable Gambling License Renewal

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Minnesota Lawful Gambling LG215 Lease for Lawful Gamblin Check applicable item: _ 1. Lease for new application. Submit with new premises permit application. ~ 2. Renewed lease. Submit with premises permit renewal. _ 3. New owner. Submit new or amended lease within 10 days after new lessor assumes ownership. Date effective _1_1_ 4. Amended lease . Check the change(s) in the lease: _Rent _Premises name _Boothlbar _Activity change _other Date that changes will be effective -!~_ . Both parties must initial and date all changes. . Submit chan es at least 10 da s rior to the chan e. Organization name !..FtO'i Sl.jPPelI CIfI\"rS-A tt~~... b_ Name of lessor (if same as legal owner, write in "SAME") G... -. -c.... Check all activities that will be conducted: -pull-tabS _Pull-tabs with dispensing device _upboards _Paddlewheel _Paddlewheel with table _Bingo _Bar bingo (OwA - Name of leased premises Street address F 10.. \. e.r- "\" '#l.l!../U ~ Business/street address ;a.HW.e...AJ. E" Business/street address 5/06 Page 1 of 2 License number I Daytime phone O~I (, ~ City Al"-der. Ills City A...Je'l City "SI-If VI-0{,7~ Daytime phone State Zip MN 56fl" State Zip mJJ 55({:/.. State Zip 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 enclosure premises by an employee of the lessor from a common area where that is distinct from areas where food and beverages are sold. food and beverages are also sold. r------------------------------------i Does your organization OR any other organization conduct gambling from a booth operation at this location? ~ Yes _ No L_________________ __________________~ If you answered yes to the question above, rent iimits are If you answered no to the question above, rent limits are baSed on the following 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 per month for all organizations at this premises. Complete one option: Option A: 0 to 10% of the gross profits per month. Percentage to be paid % The maximum rent allowed may not exceed $2/500 in total per month for all organizations at this premises. Complete one option: Option A: 0 to 20% of the gross profits per month. Percentage to be paid % Option S: When gross profits are $4,000 or less per month, $0 to Option S: 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 of gross profit. Amount to be paid $ 101 b 0 . Plus 0% to 10% of the gross profits may be paid per month on gross profits over $4/000. Percentage to be paid ID % Bingo Rent Option D: 0 to 10% of the gross profits per month from all lawful gambling activities held during bingo occasions, exduding bar bingo. Pe':"Centage to be paid % Option E: A rate based on a cost per square foot not to exceed 110% of a comparable cost per squar.e foot for leased space, as approved by the director oflhe Gambling Control Board. NO'rent may be paidror bar bingo. Rate to be paid $ per square foot. The lessor must attach dOQJmentation, verified by the organization, to confirm the comparable rate and all applicable costs to be paid by the organization to the lessor. Option C: $0 to $200 per month may be paid on the first $1,000 of gross profits. Amountto be paid $ . Pius 0% to 20% of the gross profits may be paid per month on gross profits over $1,000. Percentage to be paid % Bar Bingo Rent _ Option F: No rent may be paid for bingo conducted in a bar. New Bingo Activity For any new bingo activity not previously included in a Premises PermitAppilcation, attach a separate sheet of paper listing the days and hours that bingo will be conducted.