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Minnesota Lawful Gambling <br />LG221 Lease for Puli-Tab, <br /> <br />Paddlewheel, Tipboard, <br /> <br /> Page 1 of 2 <br /> 5/01 <br />and/or Raffle Activity. <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 <br />City State <br /> <br />Zip . Daytime Phone <br />Zip Daytime Phone <br /> <br />Name of Leased Premises <br /> <br />Street Address <br /> <br />C~ <br /> <br />Zip Daytime Phone <br /> <br />Nam.~f Lessee (name of organization leasing 'the premises) <br /> <br />Organization Ucense Number <br /> <br />Daytime 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 $ ._.,//O(~ ~ <br /> If no rent is to be paid, indicate -O- <br /> <br />Sketch and Dimensions of Leased Area <br />Sketch. For all areas being'leased for.the conduct <br />of gambling 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 />IFor Premises Permit Renewal Applications Only: If no <br />changes have been made at the site, you donor have to <br />complete this section or provide a sketch. <br /> <br />Dimensions [_ ~ ~eet for a total of ~ 0t'/ <br />The leased areas are: ~, . feet by square feet. <br /> <br /> feet by feet for a total of square feet. <br /> feet by feet for a total of square feet. <br /> Storage feet by feet for a total Of square feet. <br /> Storage feet by feet for a total of square feet. <br /> Combined total ~' square feet. <br /> <br />Lawful Gambling Activity <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br /> r--~' Paddlewhee!s E~PuiI-Tabs ~affies [~pboards' <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 />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 />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-FY, <br />you can call the Board by' using {he Minnesota Relay Service <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 />89 <br /> <br /> <br />