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:f 06 05 03:22p p.l . 763 784 9167 .,,~ , Minnesota Lawful Gambling U~215 Lease for Lawful Gambling Activity Nam~ ~f:I~C}I OWner Ofprel"!\ises Business/street address CitY"'. l Ci1y 11/04 Page 1 of2 : Sale The maximum rent allowed may not exceed the limits established under Minnesota Statute 349.18, SUbd. 1(b)(4). The limit as of May 1, 2004 is $1,750 in totII per month for all organizations at \his premises. Complete one option: Option A: 0 to 10% of the .9~ profits per month. Pen:enlage to be paid IL2- % The maximum rent anowed may not exceed the limits established under Minne50ta statum 349.18, Subd. l(bX4). . The limit as of May 1, 2004 Is $2,500 in total per mon\h for an organizations at this premises. COmplete one option: OptionAl o to 20% of the gross profi15 per month. Percentage to be paid % Option B: Wlten gross profits are $4,000 or less per month, $0 to Option B: When gross profits are $1,000 or less per month, $0 to $400 per month may be paid. Amountto be paid $ $200 per month may be paid. Amount to be paid $ Option C: $0 10$400 per month maybe paid on the ftrst $4,000 Option C: $0 to $200 per month may be paid on lhefirst$1,OOO of gross profit. Amount to be paid $ . Plus 0% to ofgrossproft15. Amount to be paid $ . Plus 0% to 10% of the gross profits may be paid per month on gross profits 20% of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid % over $1,000. Percentage to be paid % t:;hesJo:all activities that will be conducted: . ~II-tabs _Pull-tabs with dispensing device ~ds ...pacrorewheel.L;ladctiewheel with table Rent Information: Bingo Noon Hour 8ingo Occasions Rent may not exceed $25 per day for noon hour bingo conducted between 11 a.m. and 2 p.m. at a premises with a license for the sale of Intoxicating beverages on the premises. Rent to be paid per bingo occasion $ r--------------, for any new bingo activity not previously . I indoded in a Premises Pe..mitApplication,' I I attach a separate sheet of paper listing the I days and hours that bingo will be conducted. L J If this is an amended lease shOWing changes occurring during the term of the current premises pel111l~ both parties \hat signed the lease must initial and dale all changes. Changes must be S\Jbmitted to the Gambling Control Board at least 10 days prior to the change. Write in \he dam that the changes will be effective ---1---1_. lessor Date Organization Date Bingo and}or Bar Bingo Occasions Rent for bingo and all other gambling activities conducted during a bingo occasion may not exceed: . $200 per occasion for up to 6,000 square feet . $300 per occasion for up to 12,000 square teet . $400 per occasion for more than n,ooo square feet . $25 per occasion for bar bingo conducted at any time In a bar (regardless of square footage). Your organization must conduct another form of lawful gambling, and the premises must serve Intoxicating liquor or 3.2 percent malt beverages. Rent to be paid per bingo occasion $ Amended Lease Only