�� ��1 �����
<br />���� � ��a se f �r �av,r��� �a rri ��in� ���vi�}
<br />�a �H��,�� �n: � �-
<br />1 Le�,s� fornew applicauon. Submit wikh new premises permit application
<br />�. � {�x�- 5ukxni# w,� �erru�s t�e�r+�e r�.�p�u�r.
<br />S�Ofi
<br />����
<br />-- 9��-. q�rr�er. SubmEC ��.ri �-,rr,r,� 45g•�i �� 4r]�s t�lt�r �r. ti Ir_isc� na§lmta��+w+�'�� Date eSective— �.._� F-
<br />4. Ame d /ease
<br />"' . �h�thechancaefslinthelease: _ Rent _Premisesname _[�:.txd-�fi3r �,.Actfvicychange �Clther
<br />( Datethatchangeswillb�e�feGCive __ _r„ J
<br />*� partiesmust initial and date all ¢�n„yr�._
<br />Or�an�a name � � Licensenum6e ; � Daytimephone
<br />. �..��{� ���_�'� �� � � �F�� � —���� — — � _S �t����' � Cf �� ■
<br />��GS�# �� 'f"L� �� �,.rt acld, � i Cb� � i �a1P_ . � ip � a,iyG��' ��xxl�
<br />�� �� ..__. � ��� . �`r'�� . . �� ; � .� t i����i - � �',�
<br />� �c�qrJ �+�n pmrNsr�s � a1.st�e�s��rre^- avor�ss : +��n� � .��� I .�m ! �ytr�� F�
<br />—"�r#��� = �� �# �� � _ � � , �• _� #�-� I r�.� ��_ � .� � � �`�
<br />HS�mr. rr! N�w ani fif s[+f�lr- a5 i�*}<71 " j�+,i�i�r.��f��ak rwi���� �•"�y i�,1�Ler ��i� �£3�yhFtk �i��
<br />pyr�ner. ,�m�;f�.!�F."� � �
<br />Cl�k all a�tiveti$s ehat vsri-El b� toc�defct�d :
<br />��l,f�i�bs �31!-tl7bs++'�t� d+�� [�'�e� ---�'�I''°pr`� �P�rl��wl,-kF . �Name�.vr�el tiv;tr, 9a�1,� . �u,-� _ tf�7 �
<br />Pull-tab, Tipboard, and Paddiewheel Rent (r� i�� �u�� �nr ��.y
<br />B�dl, eparati� n- sak� Q ��u ��yi1r� equi�i try al'1 employee Ber opsra!'ran • 5r1� •�f S�aa►�bfrtw� etluiQ�r►t �wlti � TEt�Sed
<br />(o� vul�r�Lc-; •�1 n c�er�d brgar�urti�n withirt �-F � enctosare �remi'ses hl' m rn�pVOl'ee �af �ht: 1r_c�r. �ror+r R�orlx�►pn �„f,�e
<br />� s di'�iy"C frf9R] 3�ta� w4C+� Pe�cc! ��,e�vr:rn�* �m S�fe#. I[x,0 d� be�e�ages d�ri aM0 �Cnd.
<br />r J� �^ ^� Does your organiza�tion OR any other organi��tj�n condut�t gaerrk►ling ����� T �
<br />fr�m a kwoth aperaiion at this io�t+ott' �T'�s �€o
<br />L��—`�—..��`���.�._.��..����---- -- ..........- J
<br />ITyou answered�/@Stofhequ�tion above, rent lim'ts are
<br />based on the following ccxnbirsations of aperatinn:
<br />- �oai� oneration �
<br />- Flppti� o�eration and E�b di�t�ng t�rio�
<br />Booth aperation an� k�r ?j�r.�u
<br />- BOOth E)�es�#osli bar c�peration, and pull-tab dispensios� device
<br />T5� rria�arr�tm�i r�r�k a�rr�? m�rM rx�k��t red �i,7� ih bd1�+F
<br />G ma� t• � arga�tratsastis��r'�4$ prerr�se�
<br />Complete oneoption:
<br />Option A: f2 to 10% of the gross profits per month.
<br />Percentageto be paid ���_%
<br />Option B; When gross profits are $4,000 or less per maro�tt, $0 to
<br />�k4H1 per month may be paic#. Amour�t to be paid $
<br />Option C: $0 to $400 per month may be paid on the first $4F�0
<br />ofgroapm�"�. Amounttoaepaid $ . PIusO%to
<br />1tl°/¢ pf ttte gross �r� may pe paid per month on gross p r o f i
<br />over ��,4� - Percerttage tp`t�e�k3fd _ _, � .- —
<br />I f you art�r�d �(? to �-ques-�icx� abcNe, rent limits are
<br />based on thefolfowir� combinations of operatian:
<br />- Bar operation
<br />u o�e��'�+1C�i�-����9Gerrfo�
<br />�I �.� disperr�irx� device F�'
<br />T�r�max�lnurnrenttljlar,^�+d +yrFot+ :s��antotal
<br />pPrtr�cml� For all n�arureEianszt k�ispt'e[nis�e5.
<br />Complete o n e optian:
<br />Option A: E! to 20% of the gross profits per month.
<br />, Percentage to be paid `�a
<br />O tion B: When gross p►'oF��� �1,p� � less per ��hr ���
<br />to�200 per month may be paid. Arnount �a be paid $_ _., _
<br />E3�►tian C: $0 t� $200 p�' month may be paid on k� first $���10
<br />of g roa profits. Amountto be paid $. . . Plus Q%tn
<br />2Q°/a of ihe gross profits mayr ae p� pe� mnnth ¢r �ro� prt�
<br />over �1,Oa€7. Percentageto be paid °!a
<br />Bingo Rent
<br />Option D: Oto 10% of tl�e gross prof�is per month from a I I lawfu�
<br />gam#�ir�gact�v��reshe€� �a�a��� exdudingbarbingo.
<br />Perceniageto be paid � _`�
<br />Option E: A rate based on a c�sk per square foot not to exceed 110%
<br />o�a comparable cast per square foot for leased s{�e, as approved by
<br />thedirectoroftheG�rnbli Ga�tralBoard. Norentmaybe��lforbar
<br />bingo. Rateto be paid $ �'� � square foot.
<br />Tt� lessor must attach documentatian, verified by the organization, i�
<br />,� Bar Bingo Rent
<br />__�p�r. F: No rent may bepaid for binga
<br />avrtdu�i ir:�fa�.
<br />New S�ngo Activity
<br />rbr �,yr ��w �.��� e��,r�tyno� ��yr
<br />kxhx�i in ath�crn�st�r�t�pr��urg,
<br />�Il3�. a�XYr�ker sI�L C+f p�3 I�Xrlt� LI'ie
<br />d�v,rs anc� �our� tha[:�n9n,�" � �n� �Fu.
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