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,� , <br />� �� <br />� <br />F � �,"� <br />�� <br />p , � j p F <br />•� <br />T . � <br />\ 1[ v��i <br />� <br />���/%ii��`. T� ��' 'i�i�c�`, . <br />s <br />�' : <br />�t � A�c. �s�.�rt ,�,� �` <br />��.eme�� ' . �i► � � <br />r b_ <br />� ' �� � , � . . � � ���;� <br />� � T3 <br />�m # � � q i : `• a s ,W �. . � ' �( � <br />W Tfi/'.aJ�RA #:.� • •� '�► i�M\:`�C �M• W' � � : <br />Z{irl� ��n'ii�!i����+� .. <br />• Tc�tat �nt•c�iot ��a�d ��C,�bO per montfi ior a� <br />nan�-�go a�v�Y far t�iis prerrt�es. <br />• F�' birigo' activ�►� t�.se lease fornn LG222. <br />• For Pu�'tab disPen�i�"machu►es, ttse l�ase fo�m <br />LG223� <br />k . �" <br />��QIIOr.OfCt�. a1f1�!' <br />'P5— oza6R ot��- .('bt'�� �{.�i,— <br />nw+�• w <br />� . . . � i. ,: :. E-' <br />• Aci . may not pay r�rtt fic <br />an�r al.its a� for space used'fior <br />oi la+nrfi�l gambl�g. <br />a����,��, $ (�4D�. <br />��,���m�,�. �.�, <br />�� �� <br />` �t� � <br />. ,. <br />3e_ " " <br />( 4a�� / <br />+� 4t�' to <br />co�dtict <br />Sketch and Dimensions o# �.e�secf �- . <br />stc+�cn. t�� �� t�t foi� a,e �ona�ct � � p� �r ., <br />� �,����'��� �xo�ct � t� �:r�a� w�a,�� � � � e�, o <br />� ,�'�(��. .i�i��., ^, �{ > st?on�u�s.� �1) tf�e � t� se��s� pi�rtd:=a�slo�ls; . <br />-�- <br />Ditrtensior� �: . ,_ : , <br />The I�ed ��as �e: � feet bY _ feet for a tota! crF � squ�e feet <br />. fe� by feet for a totai � sauare f�t_ <br />feet by f�et for a totaF of squsre feet. <br />StarBge feat by feet for a totat of sq u are feet <br />. , <br />Storage feet by feet for a total of square feet <br />CombMted total square feat. <br />LaWfll� Gambling Ac#ivity � <br />�ype of gambling activity that Wil1 be conducted at this gambling premises. Check ell th� �pty. <br />� Paddlewheals E tPull-Tabs� c I Rimes � Tipboards <br />term of Lease � Amended Lease Only <br />Thetermo�this IeaseagreernerrtwiA beconcurrentwith If this is an amended I�se shawing changes occur- <br />the premises permit issued by the Gambling Contrd ring during the term of the curtent premises permit, <br />Board, unless termi�ated sooner by mutual consent of write in the date that the changes wi� be effective <br />the lessor and lessee. ! � �. Both part�s that sigried the tease <br />must initii and date ali changes. <br />Questions on this form should be directed to the Licensing The information requested on this form wiH become pub�� <br />Section of the Gambling Contrd Board (Board) at 651-639- information When received by the Board, and will be used to <br />4000. This publication wiU be made avai3abte in aiternatiie determine your c�np�ance with Mutnespta statutes and rules <br />format (i.e. large print, Br�e) upon request. Hearing impaired governing lawful gambling activities. <br />individuals using a ii'Y may caN the Minnesota Relay Service Page i of 2 <br />at I-800-627-3529 and ask to place a Call to 651-639-4000. 1199 <br />