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--------~- - ~- ----~--~- ~---~- -.-------- ------~. Minnesota Lawful Gambling LG215 Lease for Lawful Gambling Activity Ucense number - 03800 State 8/05 Page 1 of 2 Daytime phone C'e ..d~, lie. MN CIty State ; .#, lrJ.. :f' > .~-~-}f., City Slate c:..h~k all activities that will be conducted: . ~Il-tabs _Pull-tabs with dispensing device -=-,llpboards ,.l..Paddlewheel .i.Paddlewheel WIth table _~lngo.k:.Bar blngo Pull~tab, Tipboard, and Paddlewheel Rent (No lease required for raffles.) BooUt opera.tlon - sales of gambling equipment by an employee Bar operation - sales of gambling equipment within a Jeased (or volunteer) of a Dcensed organization within a separate enclosure premises by an emp'loyee of the lessor fronT a common area where that Is dJstInct froin areas where food and beverages are sold. food and beverages. are also sold. r-------D~~u~~n~~OR~~~~~~~~~~gambll~-------' , from i,'l booth operation at thIs location? .x y~ _ No L___________________~----------------J If you answered yes to the question above, rent limItS are If you a~eroo no to the QUe!tle)n !lbove, rent nmlts are based on the fonowlng combinations of operation: based on the foDowIng cornblnatlon$ of operation: _ Booth operation - Bar operation Booth operation and pull-tab dispensing device Bar operation with pun-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 lit this premises. . Complete one option: Option A: 0 to 10% of the gross profits per month. percentage to be paid / I? % \ II I The maximum rent anowed may not ~ceed $2,500 In total per montb for all organizations at thls premIseS. Complete one option: Option A: 0 to 20% of the gross proflts 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 pard. Amount to be.pald $ 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 Option C: $0 to $2~ per month may be paid on the first $1,000 of gross profit. Amountto be paid $ . Plus 0% to of gross profits. Amount to be paid $ . Plus 0% to 10% of the' gross profits may be paid Rer month on gross profJl:s 20% of the gross proflts may be paid per month on gross'proflts over $4,000. Percentage to be paid %. over $1,000. Percentage to be paid % Bingo Rent Option 0: 0 to 10% of the gross profJl:s per month from all lawful gambling activities held during bingo occasions, exdudlng bar bingo. p~centageto 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 ~t may be paid for bar bingo. Rate to be paid $ per square foot. The Iessoi- must attach doeutTtentatlon; verified by the organlzatlQn, to conflnn the cOmparable rate and all applicable costs to be paid by the organization to ~ lessor. ' Bar Bingo Rent K.. Option F: No rent may be paid for bUlgo conducted In a bar. r - - - - - ..... -.- - - - - , I For any new bingo activity not previously Included In a Premises PerrnItAppllcatlon, 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 oca.uring during the term of the aJlTent premises permit, bOth parties that signed the lease must In\tial aOO date all changes. Changes must be submitted to the Garnbnng control Board at I~ 1Q..11ay~r1or to the change. Write In the date ~1oIt(1I be effectlve~~_. I' Lesso1'" _ _Date, J6rganlzatlOJr_ . .' ~-~..- ..c'_ I .' 31