4E, Lake Region Hockey Gambling License

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Minnesota Lawful Gambling LG215 Lease for Lawful Gamblin 9.~eck applicable item: +1. Lease for new application. Submit with new premises permit application. _2. 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 _Boothlbar _Activity change _Other . Date that changes will be effective I I . Both parties must initial and date all changes. - . Submit changes at least 10 days before the effective date of the change. Organization oa e ~ License number Lo::~e lOy\ 1-\-odc'Q: ~:550 C. () f'i537 'Rame ofleased ~,:mises fI J _ i C~ I State i Zip \)\~~'-4~'(U ic) I ifti'd-'t'l) Hill::> i MN l55iQ. Name of legal owner of premises Business/street address City _ lUQ.\v~ ~\rV'- e 6{07 Page 1 of 2 r Daytime phone i~1 ;eg-'f7; \ Name of lessor (if same as legal owner, write in "SAME") ~~e. I Check (..J> all activities that will be conducted .jLpuIH:abs _PulHabs with dispensing device fC- Tipboards Paddlewheel _Paddlewheel with table ~Bingo Pull-tab, Tipboard, and Paddlewheel Rent (No lease required for rames.) 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 your oroanization OR any other orvaq'lation conduct gambling -, L from a booth operation at this location? 4- Yes _ No ----------------- ----------------~ 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 ! State ; I if-, Daytime phone 'So.~ Zip Business/street address iCily I State I ! Zip ! Daytime phone Bar bingo The maximum rent allowed may not exceed $1,750 in total per month for all organizations at this premises. The maximum rent aliowed may not exceed $2,500 in total per month for all organizations at this premises. COMPLErEONE OPITON: Option A: 0 to 10% oft~e..llross profits per month. Percentage to be paid I U % COMPLErE ONE OPITON: 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 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 D: 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 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 L Option F: No rent may be paid for bingo conducted in a bar. 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 $ per square foot. The lessor must attach dorumentation, verified by the organization, to confinn the comparable rate and all applicable costs to be paid by the organization to the lessor. New Bingo Activity For any new bingo activity not previously induded in a Premises PennitApplication, attach a separate sheet of paper listing the days and hours that bingo will be conducted.