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<br />LG215'Lease for Lawful Gambling Activity
<br />Check applicable item:
<br />_1. Lease for new application. Submit with new premises permit application.
<br />...2:2. Renewed lease. Submit wit~ premises permit renewal.
<br />_3. New owner. Effective date ---1---1_ Submit new or amended lease within 10 days after new lessor assumes ownership.
<br />4. Amended lease
<br />- · Check the change(s) in the lease: _Rent _Premises name _Boothlbar ~ctivity change _Other
<br />· Date that changes'will be effective -1--1_
<br />· Both parties must initial and date all changes.
<br />· Submit changes at least 10 days before the effective date of the change.
<br />Organization name License number
<br />
<br />'II z;-<:./ /life-AlA ;4sso~ 0'272.b
<br />Name of leased premises Street address City
<br />
<br />6/07
<br />Page 1 of 2
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<br />Jlra; 85 I1fi-Vetl
<br />Name of legal owner of premises
<br />,4 /l/rJ/tJAI, 9. J) -4 f11 I'i)
<br />Name of Ie sor (if same as legal
<br />owner, write in "SAME")
<br />gAme-"
<br />
<br />JJ:/t; 77 s " MA,.;J$ 81.rJ
<br />Business/street address
<br />J' 't; 77 :u,.- r;f~.;II~ 11fvJ
<br />Business/street address
<br />
<br />State
<br />MN
<br />
<br />Zip
<br />
<br />Da}1ime phone
<br />7&"~
<br />Lid 7-Yf6 5
<br />Daytime phone
<br />7'-S
<br />4t;;}- St.t)(J
<br />Daytime phone
<br />
<br />State
<br />
<br />7i $:JO-g
<br />Zip
<br />J')rc"'j
<br />Zip
<br />
<br />Daytime phone
<br />
<br />Booth operation . sales of gambling equipment by an employee
<br />(or volunteer) of a licensed organization within a separate endosure
<br />that is distinct from areas where food and beverages are sold.
<br />
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<br />
<br />B,ar operation -.sales 'of gambling equipment within a leased
<br />premises by an employee of the lessor from a common area where
<br />food and beverages are also said.,
<br />
<br />. . - .....
<br />.' ..... ......
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<br />
<br />If you answered yes to the question above, rent limits are.
<br />based on the following combinations of operation:
<br />- Booth operation
<br />- Booth operation and pull-tab dispensing device
<br />- Booth operation and bar operation
<br />- Booth operatic:>n, bar operation, and pull-tab dispensing device
<br />
<br />The maximum rent allowed may not exceed $1,750 in total
<br />per month for all organizations at this premises. '
<br />
<br />
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<br />
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<br />
<br />If you answered no to the question above, rent }imits are
<br />based on the following combinations of operation: '
<br />- Bar operation .
<br />- Bar operation with pull-tab dispensing device
<br />- Pull-tab dispensing device only
<br />
<br />The maximum rent allowed may not exceed $2;500 in total
<br />per month for all org,anizations at this premises.
<br />
<br />COMPLETE ONE OPllON:
<br />Option A: 0 to 10% of th~ gross profits per month.
<br />Percentage to be paid /0 %
<br />
<br />COMPLETE ONE OPTION:
<br />Option A: ' 0 to 20% of the gross profits per month.
<br />Percentage to be paid. %
<br />
<br />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
<br />$400 per month may be paid. Amount to be paid $ to $200 per month may be paid. Amount to .be paid $
<br />
<br />Option C: $0 to $400 per month on the first $4,000 of gross
<br />profit Amount to be paid $
<br />Plus, 0% to 10% of the gross profits may be paid per month on
<br />gross profits over $4,000. Percentage to be paid %
<br />
<br />Option C: $0 to $200 per month on the'first $1;'000 9f gross
<br />profits. Amount to be paid $ .'
<br />Plus, 0% to 20% of the gross profits may be paid per month on
<br />gross profits over $1,000. Percentage to be paid %
<br />
<br />
<br />Option 0: 9 to 10% of the gross profits per month from all lawful
<br />gambling activities held during bingo occasions, excluding bar bingo.
<br />Percentage to be paid %
<br />
<br />Option E: A rate based on a cost per square foot, not to exceed
<br />110% of a comparable cost per square foot for leased space, as
<br />approved by the director of the Gambling Control Board. No rent may be
<br />paid for bar, bingo. Rateto be paid $ per square foot. .
<br />The lessor must attach documentation, verified by the organization, to
<br />confirm the comparable rate and all applicable costs to be paid by the
<br />organization to the lessor.
<br />
<br />For any new bingo activity not previously
<br />included in a Premises P~rmitApplication, .,.,_",
<br />attach a separate sheefof paper liSting the
<br />days and hours that bingo will be conducted.
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<br />-80-
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