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Minnesota Lawful Gambling LG215 Lease for Lawful Gambling Activity 8/05 Page 1 of 2 Organization name Ucense number Daytime phone f)c~.t.? 8/0' { c.. .J;~fJk c~..? B -038 oe> ~-i'-Y-1ZZ~1,.- Name ofleased premises Street address City State Zip Daytime phone 'rr-JName of legal owner of premises Business/street address City State Zip I Daytime phone ~I 11't.'lIL~r.u~ (,5"/0 c.~"zk"..v.~ /let! /.;/1-1# k Ie-- /tV 5"1011/ 1~.:77-r'.?t~ Zj';~ Name of lessor (if same as legal Business/street address City State Zip Daytime phone owner, write in "SAME") .j ~rtt.. G-- c;~ck all activities that will be conducted: . ~Pull-tabs _Pull-tabs with dispensing device _ Tipboards -iPaddlewheel _Paddlewheel with table _Bingo _Bar bingo 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 endosure premises by an employee of the lessor from a common area where that is distinct fro.m areas where food and beverages are sold. food and beverages are also sold. r-------~esyoU~rganizati;ORany~her~ani~onductgambling-------, from a booth operation at this location? Yes No L_________________________==_________~ If you answered yes to the question above, rent limits are If you answered no to the ques~~n above, rent iimits are based on the following combinations of operation: based on the following combinatio~s 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 .i The maximum rent allowed may not exceed $1,750 in tota/_ per month for all organizations at this premises. The maximum rent allowed may not exceed $2,500 in total per montl:1 for all organizations at this premiseS. Complete one option: Option A: 0 to 10% of the gross profits per month. Percentage to be paid ,J' % Option B: When gross profits are $4,000 or less per month, $0 to $400 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 10% of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid % Complete one option: Option A: 0 to 20% of the gross profits per month. Percentage to be paid _ .:,:_ - . _ % Option B: When gross profits are $1,000 or less per month, $0 to $200 per month may be paid. Amount 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 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 _% Bar Bingo Rent _ 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 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 I included in a Premises Permit Application, I I attach a separate sheet of paper listing the I days and hours that bingo will be conducted. L____________...J Amended Lease Only If 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 all 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 --1--1_. Lessor Date Organization Date y:~