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Minnesota Lawful Gambling LG215 Lease for Lawful Gamblina Activitv 8/03 Pace 1 of 7 Name of legal owner of premises Street address City State Zip Daytime phone Ci LL� `1 /�aV 1 a e of lessor Street dress City Slate Zip Daytime phone (If same as legal owner, write in "SAME ") Name of leased premises Street address City Zip Daytime phone / 1 e Name of lessee (organization leasing the premises) /Organization license number Daytime phone %0A IAXILe" e. g Rent Information (for activity involving pull -tabs, tipboards, paddlewheels, and pull -tab dispensing devices. No lease required for raffles.) Booth operation - sales of gambling equipment by an employee (or Bar operation -sales of gambling equipment within a leased volunteer) of a licensed organization within a separate enclosure that is premises by an employee of the lessor from a common area where distinct from areas where food and beverages are sold. _ — — and beverages are also sold. — —food — — — — — — — — — — — — r Does your organization OR any other organization conduct gambling from a booth operation at this L--------------------- location? Yes No — -------------- –I If you answered yes to the question above, rent limits are If you answered no to the question above, rent limits are based on the following combinations of operation: based on the following combinations 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 The maximum rent allowed may not exceed $1,750 in The maximum rent allowed may not exceed $2,000 in total per month for all organizations at this premises. total per month for all organizations at this premises. Complete one option: Complete one option: Option A: 0 to 10% of the gross profits per month. Option A: 0 to 20% of the gross profits per month. Percentage to be paid — % 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 to $400 per month may be paid. Amount to be paid $ $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 $200 per month may be paid on the first $1,000 of gross profit. Amount to be paid $ . Plus 0% to of gross profits. 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 % NOTE: If there are any other terms or conditions for rent - related Check all activities that will be conducted: expenses, they must be identified on page 2 under Acknowledgment —Pull-tabs Pull -tabs with dispensing device of Lease Terms and are subject to Board approval. —_Tipboards _Paddlewheel — Paddlewheel with table Rent Information: dingo Bingo and /or Bar Bingo Occasions Noon Flour Bingo Occasions a Rent for bingo and all other gambling activities conducted during a bingo occasion may not exceed: Rent may not exceed Y $ per day for noon hour $200 per occasion for up to 6,000 square feet bingo conducted between 11 a.m. and 2 p.m. at a $300 per occasion for up to 12,000 square feet premises with a license for the sale of intoxicating ® $400 per occasion for more than 12,000 square feet beverages on the premises. ® $25 per occasion for bar bingo conducted at any time in a Rent to be paid per bingo occasion $ bar (regardless of square footage). Your organization must conduct another form of lawful gambling, and the r For any new bingo activity not previously premises must serve intoxicating liquor or 3.2 percent included in a Premises Permit Application, malt beverages. Rent to be aid per bingo occasion $ ®� � � P I attach a separate sheet of p parr listing the days hours bingo P 9 e and that will be conducted. L---------- - - - --i ., Amended 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. Lease 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 effectiveJ Only —� Lessor Date Organization Date