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Minnesota Lawful Gambling <br />LG221 Lease for Puli-Tab, Paddlewheel, <br /> <br /> Page 1 of 2 <br /> 5/01 <br />Tipboard, and/or Raffle Activity. <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Name of Legal Owner of Premises Street Address <br /> <br />Name of Lessor Street Address <br />(If same as legal owner, write in "SAME') <br /> <br />City State Zip <br /> <br />Daytime Phone <br /> <br />Daytime Phone <br /> <br />Name of Leased Premises Street Address <br /> <br />Name of Lessee (name of organization leasing the premises) <br /> <br />Cb Zip Daytime Phone ~.../. r . <br /> <br />Organ~atJon License Number Oa~ime Phone. <br /> <br />Rent Information <br /> <br />1. Total rent cannot exceed $1,000 per month for all <br /> non-bingo activity for this premises. <br /> <br />2. For bingo activity, use lease form LG222. <br /> <br />3. For pull-tab dispensing machines, use lease form <br /> LG223. <br /> <br />4. An organization may not. pay rent to itself or to any <br /> of its affiliates for space used for the conduct of <br /> lawful gambling. <br /> <br />5. Rent to be Paid per month <br /> <br />If no rent is to be paid, indicate -0- <br /> <br />I <br />I <br />! <br />I <br />I <br /> <br />i Sketch and Dimensions of Leased Area <br /> Sketch. For all areas being leased forthe conduct <br /> of gambiing and storage of gambling product at this <br /> premises, attach a sketch (drawing) showing: <br /> (1) the leased area(s), and (2) the dimensions. <br /> <br />For Premises Permit Renewal Applications Only: If no <br />changes have been made at the site, you do not have to <br />complete this section or provide a sketch. <br /> <br />Dimensions <br />The leased areas are: (~ feet by "7 feet for a total of <br /> ..} feet by ~ feet for a total of <br /> feet by feet for a total of <br />Storage feet by feet for a to{al of <br />Storage feet by feet for a total of <br /> combined total <br /> <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br /> <br />t'Lawful Gambling Activity ' <br />IType of gambling activity that will be conducted at this gambling premises. Check all that apply.. <br /> <br />I ~ Paddlewheels [Z'PulI-Tabs r~ Raffles ~ Tipboards <br /> <br />Term of Lease <br />The term of this lease agreement will be concurrent with <br />the premises permit issued by the Gambling Control <br />Board, unless terminated sooner by mutual consent of <br />the lessor and lessee. <br /> <br />Questions on this form should be directed to the Licensing <br />Section of the Gambling Control Board (Board) at 651-639- <br />4000. This publication will be made available in alternative <br />format (i.e. large print, Braille) upon request. If you use a -I-r% <br />you can call the Board by using the Minnesota Relay Service <br /> <br />Amended Lease Only <br />If this is an amended lease showing changes occur- <br />ring during the term of the current premises permit, <br />write in the date that the changes will be effective <br />__/__/__. Both parties that signed the lease <br />must initial and date all changes. <br /> <br />and ask to place a call to 651-639-4000. The information <br />requested on this form will become public information when <br />received by the'Board, and will be used to determine your <br />compliance with Minnesota statutes and rules governing <br />lawful gambling activities. <br /> <br />-81- <br /> <br /> <br />