Agenda - Council - 04/22/2003 - Laserfiche WebLink

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Page I of 2 Minnesota Lawful Gambling 5/Ol LG221 Lease for Puli-Tab, Paddlewheel, Tipboard, and/or Raffle Activity- I I I I I I Name of L~jal Owner of Premises Street Address C~ Name of Lessor/ Street Address City (If same as legal owner, wri[e in "SAME") State Zip Daytime Phone State Zip Daytime Phone Name of Leased Premises . Street Address Name of Lessee (name of organization leasing the premises) City Zip Daytime Phone OrganizatiOn Ucense Number Daytime Phone. Rent Information 1. Total rent cannot exceed $1,000 per month for all non-bingo activity for this premises. 2. For bingo activity, use lease form LG222. 3. For pull-tab dispensing machines, use lease form' LG223. 4. An organization may not pay rent to itself or to any of its affiliates for space used for the Conduct of lawful gambling. 5. Rent to be paid per month $ If no rent is to be paid, .indicate ~0- Sketch and Dimensions of Leased Area Sketch. For all areas being 'leased for the conduct of gambling and storage of gambling product at this premises, attach a sketch (drawing) showing: (1) the leased area(s), and (2) the dimensions. For Premises Permit Renewal Applications Only: If no changes have been made at the site, you do not have to complete this section or provide a sketch. Dimensions The leased areas are: ~ feet by ~ feet fo~ a total of feet by feet for a total of feet by feet for a total of Storage .~ feet by .5"'- feet for a total of Storage feet by feet for a total of Combined total /2- square feet. square feet. square feet. square feet. square feet. square feet. Lawful Gambling Activity ' Type of gambling activity that will be conducted at this gambling premises. Check all that apply. Term of Lease The term of this lease agreement will be concurrent with the premises permit issued by the Gambling Control Board, unless terminated sooner by mutual consent of the lessor and lessee. Amended Lease Only If this is an amended lease showing changes occur- ring during the term of the current premises permit, write in the date that the changes will be effective __/__/__ Both parties that signed the lease must initial and date all changes. Questions on this form should be directed to the Licensing and ask to place a call to 651-639-4000. The information Section of the Gambling Control Board (Board) at 651-639- 4000. This publication will be made available in alternative format (i.e. large print, Braille) upon request. If you use a TT%, you can call the Board by using the Minnesota Relay Service requested on this form will become public information when received by the Board, and will be used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities. 93.