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<br />Minnesota Lawful Gambling
<br />LG215 Lease for Lawful Gamblin
<br />
<br />
<br />6/07
<br />Page 1 of 2
<br />
<br />Check applicable item:
<br />$- 1. Lease for new application. Submit with new premises permit application.
<br />___2. Renewed lease. Submit with premises permit renewal.
<br />___3. New owner. Effective date ____L_"__I____ Submit new or amended lease within 10 days after new lessor assumes ownership.
<br />4. Amended lease
<br />. Check the change(s} in the lease: ___Rent ___Premises name ___Booth/bar __Activity change __Other
<br />. Date that changes will be effectiv8_____I____I_____
<br />. Both parties must initial and date all changes.
<br />. Submit changes at least 10 days before the effective date of the change.
<br />
<br />Organization name License number Daytime phone
<br />
<br />Cod-\ ~~o..\t';',",- Cl4'd.41 "'5\- (,?'~-W"
<br />--~-~-'----_._----------_._----_._----- -~~-
<br />
<br />Nameofleased premises Street address City
<br />
<br />i: h~1.n~~___L~~J?, W~ Qo'_~c:I. ~___ ~~'" \~~~'S
<br />Name of legal owner of premises! Business/street address City
<br />
<br />E~~-h~s~~ i B~tSress C~~C-
<br />
<br />owner, write in "SAME") l
<br />~~ 'L S .;;).ry\'L
<br />;[~h~.dk,:bh':all',ClQ:iY'i~i,~,$,~6at}~'iIl-:,ij~..~~,iijM:<[J::~~fn;:: ',\ ~:![~~~ii~~~li~i~f~f~4,j[&;i ll:}f%~~\4I~i~1~11~t~?~~4~4f~~~*~~*ft
<br />XPull-tabs _Pull-tabs with dispensing device )lTipboards :X-Paddlewheel _Paddlewheel with table _Bingo )lBar bingo
<br />PU. n.tab.....Ti"i:l6at.di.and.Palil!:lj~j,iI,}j6.t<fl~iif:"~~+:wlN'Y,~~~;iZ.1!i\i3~~ifl~\i~~~~~.~ii~~~l.~
<br />c-.... ....".",. .,~",. ..,n. . ",n,n. .... _,.'.,' ....,'~.,'_..,"",...,)""'~i'hii!l~~t"..~4!i!Qh~i"""",,,'.^^^~Y:!~nf~~~1i1i!~V,^,4YJf"H0~ 0-,,,,s.,,,.J,,,,,,^,,,,o.
<br />Booth operation - sales of gambling equipment by an employee Bar operation M sales of gambling equipment within a leased
<br />(or volunteer) of a licensed organization within a separate enclosure premises by an employee of the lessor from a common area where
<br />that is dIstinct from areas where food and beverages are sold. food and beverages are also sold.
<br />
<br />State
<br />
<br />Zip
<br />
<br />Daytime phone
<br />
<br />MN
<br />
<br />"'C:;II~
<br />i Zip Daytime phone
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<br />Zip
<br />
<br />Daytime phone
<br />
<br />State
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<br />State
<br />
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<br />'So-rn<i:...
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<br />Doe:'s~" . '" .
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<br />
<br />If you answered yes to the question above, rent limits are
<br />based on the following combinations of operation:
<br />Booth operation
<br />Booth operation and pull~tab dispensing device
<br />Booth operation and bar operation
<br />Booth operation, bar operation, and pUll-tab dispensing device
<br />
<br />
<br />If you answered no to the question above, rent limits are
<br />based on the following combinations of operation:
<br />Bar operation
<br />Bar operation with pull-tab dispensing device
<br />Puil-tab dispensing device only
<br />
<br />The maximum rent allowed may not exceed $1,750 in total
<br />per month for all organizations at this premises.
<br />
<br />The maximum rent allowed may not exceed $2,500 in total
<br />per month for all organizations at this premises.
<br />
<br />COMPLETE ONE OPTION:
<br />Option A: 0 to 10% ofthe-9ross profits per month.
<br />Percentage to be paid 10 %
<br />
<br />COMPLETE ONE OPTION:
<br />Option A: 0 to 20% of the gross profits per month.
<br />Percentage to be paid %
<br />
<br />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
<br />$400 per month may be paid. Amount to be paid $ to $200 per month may be paid. Amount to be paid $
<br />
<br />Option c: $0 to $400 per month on the first $4,000 of gross
<br />proAt. Amount to be paid $
<br />Plus, 0% to 10% of the gross profits may be paid per month on
<br />gross profits over $4,000. Percentage to be paid _%
<br />
<br />Bil19gRent
<br />
<br />Option D: 0 to 10% of the gross profits per month from all lawful
<br />gambling activities held during bingo occasions, excluding bar bingo.
<br />Percentage to be paid ___ %
<br />
<br />Option C: $0 to $200 per month on the first $1,000 of gross
<br />profits. Amount to be paid $
<br />Plus, 0% to 20% of the gross profits may be paid per month on
<br />gross profits over $1,0'00., Percentage to be paid %
<br />
<br />Option E: A rate based on a cost per square foot, not to exceed
<br />110% of a comparable cost per square foot for leased space, as
<br />approved by the director of the Gambling Control Board. No rent may be
<br />paid for bar bingo. Rate to be paid $ per square foot.
<br />The lessor must attach documentation, verified by the organization, to
<br />confirm the comparable rate and all applicable costs to be paid by the
<br />organization to the lessor.
<br />
<br />
<br />For any new bingo activity not previously
<br />included ina Premises Permit Application,
<br />attach a separate sheet of paper listing the
<br />days and hours that bingo will be conducted.
<br />
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