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Minnesota Lawful Gambling 8/03 LG215 Lease for Lawful Gamblin Activit Paee � of z Name of legal owner of premises Street address City State Zip DayUme phone JOHN PAVLICK 1754 LEXINGTON AVE. ROSEVILLE MN 1 1-4 Name of lessor Street address Ciry State Zip Daytime phone (If same as legai owner, write in "SAME") SAME Name of leased premises Street address City T�p Daytime phone OL' MEXICO 1754 LEXINGTON AVE. ROSEVILLE MN 55113 651-487-2847 Name of lessee (organization leasing the premises) Organizatlon license number Daytime phone TSE INC. - - Rent Information (for activity involving puil-tabs, tipboards, paddlewheels, and puli-tab dispensing devices. No lease requfred for raffles.) Booth operatlon • sales of gambiing equipment by an employee (or Bar operatlon - sales of gambling equipment within a leased volunteer) of a Bcensed organizatlon within a separete enclosure that is premises by an employee of the lessor from a common area where distlnct from areas where food and beverages are sold. food and beverages are also sold_ ___ ---------------------- ------ r poes your organizatlon OR any othe� oryanization conduct gambliny , irom a booth operadon at this locatlon? �_ Yas No �------------�-------------- ---------------� If you answered yeS to the question above, rent Ifmits are If you answered I10 to the question above, rent Iimlts are based on the fnllowi�g oombinatfons of operatfon: based on the following wmbinatlons of operation: - Booth operadon - Bar operation - Booth operatlon and pull-tab dispensing device - Bar operation with pull-tab dispensing dev(ce - Booth operation and bar operation - Pull-tab dispensing device anly - Booth operation, bar operatlon, and pull-tab dispensing device The maximum rent aliowed may not exceed $1,750 In The maximum rent aliowed may not exceed $2,000 in total per month for all organizations at this premises. total per montt� for ali organizations at this premises. Complete one opdon; Complete one opdon: 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 �Q% Percentage to be pald % Optlon B: When gross proflts are $4,000 or less per month, �0 to Option �: 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 g Optlon C: $0 to #400 per montfi may be paid on the flrst $4,000 Optlon C: $0 to �Z00 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 p�ofits may be paid per month on gross proflts over $4,000. Percentage to be pald % over #1,000. Percentage to be pafd % NOTE: If there are any other terms or conditions for rent-related Chedc all activ(ties that will be conduded: expenses, they must be identified on page 2 under Acknowledgment .�Pull-tabs Pull-tabs with dispensing device of Lease Terms and are sub ect to Board approval. Tpboards ^Paddlewheel ,_Paddlewheel with table Rent Information: Bingo Bingo and/or Bar Bingo Occasions Noon Hour Bingo Occasions Rent for b(ngo and all other gambling activ(ties Rent may not exceed $25 per day for noon hour conducted during a bingo occasion may not exceed: •$200 per occas(on 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 iicense for the sale of intoxfcating .$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 organfzation must rnnduct another form of lawful gambling, and the r For any naw bingo activity not prevlousiy , premfses must serve (ntoxfcating Iiquor or 3.2 percent malt beverages. � included in a Premises Permit Application, � � attach a separate sheet of paper listing the 4 Rent to be pald per bingo occasion $ days and hours that b(ngo will be conducted. L_ ,J Am ended if this is an amended lease showing changes occurring during the term of the current premises permit, both parties Lease khat signed the lease must initial and date all changes. Changes must be submitted to the Gambling Control Board at least 10 days prior to the change. Write in the date that the changes wiil be effective �/_� Only Lessor Date Organizatfon Date