Agenda - Council - 03/10/2009 - Laserfiche WebLink

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Minnesota Lawful Gambling 6/07 LG215 Lease for Lawful Gambling Activity Page -1 of 2 Check applicable item: 1. Lease for new application. Submit with new premises permit application. — 2. Renewed lease. Submit with premises permit renewal. 3. New owner. Effective date _/ / Submit new or amended lease within 10 days after new lessor assumes ownership. 4. Amended lease • Check the change(s) in the lease: Rent _Premises name Booth/bar Activity change • Date that changes will be effective I I _Other • Both parties must initial and date all changes. • Submit changes at least 10 days before the effective date of the change. Orga name License number Daytime phone Name of leased premises Street address City State Zip Daytime phone dtJi -4 2'r 'PS L� '765i> - d 0;' /b 1c,'� 0, t� a vv` 5e � �"��'a.5 �� Name of legal owner of premises Business /street address City State Zip Daytime phone G 7v mSZ4 1+r,N , 1 SS��.P5 �7 ��" ". 3� • Name of lessor (if same as legal "SAME Business /street address City State Zip Daytime phone owner, write in ") �Av-v. Check:(q):ail activities that will be conducted ✓Pull -tabs —Pull-tabs with dispensing device ITipboards _Paddlewheel _Paddlewheel with table _Bingo — Bar bingo P ull -tab, Tipboard and Paddlewheel Rent (No lease-required for.raf les.) Booth operation - sales of gambling equipment by an employee Bar operation - sales of gambling equipment within a leased (or volunteer) of a licensed organization within a separate enclosure premises by an employee of the lessor from a common area where that is distinct from areas where food and beverages are sold, food and beverages are also sold. t- Does yQur organization OR any other organization conduct ;gambling from a.booth operation at this' location? _ ✓' Yes No _ _ _ _ _ _ _ _ _ J If you answered yes to the question above, rent limits are If you answered n ®to the question above, rent limits are based on the following combinations of operation: based on the following combinations of operation: - Booth operation - Bar operation . - Booth operation and pull -tab dispensing device - Bar operation with pull -tab dispensing device - Booth operation and bar operation - Pull -tab dispensing device only - Booth operation, bar operation, and pull -tab dispensing device The maximum rent allowed may not exceed $1,750 in total The maximum rent allowed may not exceed $2,500 in total per month for all organizations at this premises. per month for all organizations at this premises. COMPLETE ONE OPTION: COMPLETE ONE OPTION: 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 14 % Percentage to be paid 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 $400 per month may be paid. Amount to be paid $ to $200 per month may be paid. Amount to be paid $ Option C: $0 to $400 per month on the first $4,000 of gross Option C: $0 to $200 per month on the first $1,000 of gross prit. Amountto'be paid $ profits. Amount to be paid $ Plus, 0% to 10% of the gross profits may be paid per month on Plus, 0% to 20% of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid % gross profits over $1,000. Percentage to be paid % Bingo Rent Bar Bin* go:Rent . Option D: 0 to 10% of the gross profits per month from all lawful Option F: No rent may be paid for bingo gambling activities held during bingo occasions, excluding bar bingo. conducted in a bar. Percentage to be paid % Option E: A rate based on a cost per square foot, not to exceed New Bin A 110% of a comparable cost per square foot for leased space, as approved by the director of the Gambling Control Board. No rent may be For any new bingo activity not previously paid for bar bingo. Rate to be paid $ - per square foot. The lessor must attach documentation, verified by the organization, to included in a Premises Permit Application, confirm the comparable rate and all applicable costs to be paid by the attach a separate sheet of paper listing the organization to the lessor. days and hours that bingo will be conducted. .1f 6 �61-