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<br />Minnesota Lawful Gambling <br /> <br />Lease for Pull-Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 <br />Name of Legal Owner of Premises Street Address City state Zip Daytime Phone <br />oif-t.- IYe.-;/I 7701" bP~ /i'C",L-'-=A_(."" /o/",V' s:$"o/-, U/-C.:>3- 70 <br />Name of Lessor Street Address City state Zip Daytime Phone <br />(If same as legal owner, write In "SAME") <br />A-lIrl r h../-.5e.-f C8f'? c~~v-,/k..eR .,.~~",Ik /"7;l/,5Jo38"ai7i-t::'-3 I/g?, <br />Name of Leased Premises Street Address City Zip Daytime Phone <br /> <br />tv,,'se.c..-. J ,4-ZZ"t-Q.-,P....J 7o?5'" ~.$ ,c:c~~v,/lc- /rP.>50 6/-&5'3 /077 <br />Name of Lessee (name of organization leasing the premises) GeB license no. of organization Daytime Phone <br />oc",~ Sr<>~..- ~ c--k..5 8-038= ~/- 9'?.y- 7z.z <br /> <br />Rent Information <br /> <br />Lawful Gambling Activity <br />Type of gamb. Iing.sgjivity that will be conducted. at this gambling premis~. Check all t <br />/cl~Y~ J::I:;~:: ~UII-Tab~t~;i;: <br /> <br />erm of Lease Amended Lease Only <br /> <br />The term of this lease agreement will be concurrent with If this is an amended lease showing changes occur- <br />the premises permit issued by the Gambling Control ring during the term of the current premises permit, <br />Board, unless terminated sooner by mutual consent of write in the date that the changes will be effective <br />the lessor and lessee, ~.--i.L.J eZ-. Both parties that signed the lease <br />must initial and date all changes. <br /> <br />. Total rent cannot exceed $1,000 per month for all <br />non-bingo activity for this premises. <br /> <br />. For bingo actMty, use lease form LG222. <br /> <br />. For pull-tab dispensing machines, use lease form <br />LG223. <br /> <br />Sketch and Dimensions of Leased Area <br /> <br />SketCh: For all areas being leased for the conduct <br />of gambling and storage of gambling product at this <br />premises, attach a sketch (drawing) showing: (1) the <br />leased area(s), and (2) the dimensions. <br /> <br />Dimensions <br />The leased areas are: <br /> <br />c:; <br /> <br />8' <br /> <br />feet by <br />feet by <br />feet by <br />feet by <br />feet by <br /> <br />Storage <br />Storage <br /> <br />I <br /> <br /> <br />. An organization may not pay rent to itself or to <br />any of its affiliates for space used for the conduct <br />of lawful gambling. <br /> <br />Rent to be paid per month $ <br />(If no rent is to be paid. indicate -0-) <br /> <br />/00 <br /> <br />For Premises Permit Renewal Applications Only: If no <br />changes have been made at the site, you 0'0 not have to <br />complete this section or provide a sketch. <br /> <br />feet for a total of <br />feet for a total of <br />feet for a total of <br />feet for a total of <br />feet for a total of . <br />Combined total <br /> <br />4/8 <br /> <br />square feel. <br /> <br /> <br />square feel. <br /> <br />square feet. <br /> <br /> <br />square feel. <br /> <br /> <br />square feel. <br /> <br /> <br />square feel. <br /> <br /> <br /> <br />,,4\.-, <br />t app1ti( "A'f~! <br />(/ /F"t '- n <br />Tipboards 9.}9/':'" <br /> <br />Questions on this form should be directed to the Licensing <br />Section of the Gambling Control Board (Board) at 651-639- <br />4000. This pubiicatlon will be made available In alternative <br />format (i.e. large print. Braille) upon request. Hearing impaired <br />indMduals using a 1TY may call the Minnesota Relay Service <br />at 1-80Cl-627-3529 and ask to place a call to 651-639-4000. <br /> <br />The information requested on this form will become pubiic <br />information when received by the Board, and will be used to <br />determine your compfiance wilh MinneSota statutes and rules <br />governing lawful gambiing activities. <br /> <br />page 1 of 2 <br />. 1/99 <br />