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° Minnesota Lawful Gambling <br />LG215 Lease for Lawful Gambling Activity <br />5/08 Page 1 of 2 <br />Ch k applicable item: <br />1. Lease for new application. Submit with new premises permit application. <br />2. Renewed lease. Submit with premises permit renewal. <br />3. New owner. Effective date Submit new or amended lease within 10 days after new lessor assumes ownership <br />Q4. Amended lease <br />Check the change(s) in the lease: Rent ,Premises name Booth /bar Activity change Other <br />, <br />- Date that changes will be effective <br />- Both parties must initial and date all changes. <br />- Submit changes at least 10 days before the effective date of the change. <br />Or ization name // / <br />License number <br />/ <br />�aytm a phone <br />P L 4�S /�! <br />� <br />a/�U <br />Z a is7 r <br />ame of lea ed premises Street address <br />City <br />State Zip <br />Daytime phone <br />L L ) -1A44 . 2 0 li `(7yz <br />.vl+S t <br />MN <br />Name f legal owner of premises! Business address <br />Ci <br />State Zip <br />Daytime phone . <br />it <br />/QG(o LL r: N� <br />4W�yP <br />l 4J3'[7 S' <br />221 _ p - 2 }' <br />Name of lessor (i same as legal Business /street address <br />City <br />1 Zip <br />Daytime phone <br />_ <br />oo write ih "SAME ") I �a )- O <br />- <br />late <br />I <br />?, <br />/�'G�j4Kd lrGfZ14 A I /f �"a /d N"� <br />GNJ� <br />I S"13Cj� <br />� <br />Ch k all activities that will be Con Licted <br />Pull -tabs D.Pull -tabs with dispensing device gLTipboardsaPaddlewheel aPaddlewheel with table aBingo [LBar bingo <br />Pull- tab,.Tlpboafd, and Paddlewheel Rent. (No lease required for raffles.) <br />Booth operation - sales of gambling equipment by an employee Bar operation - sales of gambling equipment within a leased <br />(or volunteer) of a licensed organization within a separate enclosure premises by an employee of the lessor from a common area where <br />that is distinct from areas where food and beverages are sold. food and beverages are also sold. <br />I -=----- - - - - -- — - - - -- -- - - - - -� <br />Does our or antzation OR any other org aniz "on conduct gambling <br />from a booth operation' I at this locations Yes LL-j No <br />L---- °----- - - - - -- --------- - - - - -J <br />If you answered yes to the question above, rent limits are If you answered no to the question above, rent limits are <br />based on the following combinations of operation: based on the following combinations of operation: <br />- Booth operation and pull -tab dispensing device - Bar operation <br />- Booth operation and bar operation - Bar operation with pull -tab dispensing device <br />- Booth operation, bar operation, and pull -tab dispensing device - Pull -tab dispensing device only <br />- Booth operation <br />The maximum rent allowed may not exceed $1,750 in The maximum rent allowed may not exceed $2,500 in <br />total per month for all organizations at this premises. total per month for all organizations at this premises. <br />COMPLETE ONE OPTION: COMPLETE ONE OPTION: <br />Option A: 0 to 10% of the gross profits per month. Percentage <br />to be paid � % Option d 0 to 20% of the gross profits per month. Percentage <br />to be pa <br />Option S: When gross profits are $4,000 or less per month, $0 O profits are 1 <br />to $400 per month may be paid. Amount to be paid $ Option B: When gross P $ , 000 or less per month, $0 <br />to $200 per month may be paid. Amount to be paid $ <br />Option C: $0 to $400 per month on the first $4,000 of gross <br />profit. Amount to be paid $ Option C: $0 to $200 per month on the first $1,000 of gross <br />Plus, 0% to 10% of the gross profits may be paid per month on profits. Amount to be paid $ . Plus, 0% to 20% of <br />gross profits over $4,000. Percentage to be paid % the gross profits may be paid per month on gross profits over <br />$1,000. Percentage to be paid. % <br />Bingo Rent <br />Bar Bingo Rent <br />Option D: 0 to 10 of the gross profits per month from all lawful <br />gambling activities held during bingo occasions, excluding bar bingo. <br />Option F: No rent may be paid for bingo <br />Percentage to be paid % <br />conducted in a bar. <br />Option E: A rate based on a cost per square foot, not to exceed <br />New Bingo Activity <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 <br />be paid for bar bingo. Rate to be paid $ per square foot. <br />For any new bingo activity not previously <br />The lessor must attach documentation, verified by the organization, to <br />included in a Premises Permit Application, <br />confirm the comparable rate and all applicable costs to be paid by the <br />attach a separate sheet of paper listing the <br />organization to the lessor. <br />days and hours that bingo will be conducted. <br />-50- <br />