4D, St. Mary Romanian Gambling License

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LG215 Lease for Lawful Gambling Activity Check applicable item: -v-1. Lease for new application. Submit with new p. remises permit application. -A2. Renewed lease. Submit with premises permit renewal. _3_ New owner. Effective date _1_/_ Submit new or amended lease within 10 days after new lessor assumes ownership. _4. Amended lease . Check the change(s) in the lease: _Rent _Premises name _Booth/bar _Activity change _Other . Date that changes will be effective _'_I_ . Both parties must initial and date all changes. . Submit changes at least 10 days before the effective date of the change. Organization name 51- /Vl,f t- i License number {3.;,MWI4N of.1/foO"'X cHued! ooL.(BCJ NAme of leased premises I. Street address City j:'<.>'l 0 G-oLD i '77(, G:>N/llli/.-Ly /f-evG:,U I N~me of legal owner of premises I ~ Business/street address (;-01-0/6- S I e Ih.J 1?77(. C-"f'/iU,z!-t-'( Name of lessor (if same as legal I Business/street address owner, write in "SAME") : <; It tv( L Check (..JJall activitiesthatwillbecol1ducted Null-tabs _Pull-tabs with dispensing device _ Tipboards _Paddlewheel _Paddlewheel with table 4BlngO _Bar bingo Pull-tab, Tipboard, and Paddlewheel Rent (No lease requiredJor 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-----~~~~-~-~~---~------~---------., Does ,vll.lJr:~mar1izClti~r1 ORanvother oraanization conduct gambling L ____ _ _l.rorfl'~:-bo:oth:()~~rationatthisloca~~n'?_ ...... .y~ ". .......No......... __-,-~-,-_-,-..J 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 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 Minnesota Lawful Gambling 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 % 6/07 Page 1 of 2 Daytime phone state /f/LL~ MN Zip ))1 .. 1... Daytime phone G ,I GJI (7).'1 City /- !f'UI ./He Q,E.AJ State I'lAJ Zip j)\ (1- Daytime phone Gr-I q/ (72-'/ Daytime phone City State Zip 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 on the first $4,000 of gross profit Amountto be paid $ Plus, 0% to 10% of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid % Bingo Rent Option 0: 0 to 10% of the gross profits per month from all lawful gambling activities held during bingo occasions, excluding barbingo. 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 bingo. Rate to be paid $ ). I. '" Dper 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. Option C: $0 to $200 per month 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 % 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 PermitApplication, attach a separate sheet of paper listing the days and hours that bingo will be conducted.