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..Minnesota Lawful Gambling—.....-.,
<br />Lease for Pull -Tab;, Paddlewheel; TipboaM,"aKdfor Raffle Activity ., LG221
<br />Name of Legal Owner of Premises StreetAddress
<br />city Zip
<br />Daytime Phone
<br />CwTe- fit': '6�3�
<br />lr-Taiti- fte
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<br />Name of Lessor Street Address
<br />City Zip
<br />Daytime Phone
<br />(if same as legal owner, write in "SAME"]
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<br />Name of Leased Premises Street Address.
<br />city Zip
<br />Daytime Phone
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<br />Name of Le --see (name of organization leasing the premises)
<br />r-CR license no. of organization
<br />Daytime Phone
<br />C)o QL
<br />Q-2
<br />Rent Information
<br />Total rent cannot. exceed $1,000 per. monthfor all.. An _organization may'. not pay rent to itself or to
<br />non -bingo activity for this premises... any of its affiliates for space used for the conduct
<br />Z
<br />of lawful qamb,![!'n
<br />bin-gio"'activity, use'lease f6rm'LG222...,..,.'..
<br />Fdr pull -tab dispensirlib -machines, use lease form!.,.
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<br />L6223.-',-�•""P Z, Lent to be, aid
<br />perrnonth*.'� j.
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<br />;o :zyj;4e� (if no rent. is'to 6� paid, Indicate.0
<br />'66A66" IL k6i6f�i6dDim s s'of ease
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<br />[Sketch-
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<br />F, 1 '0 V J'jigo d 'n' c v
<br />stora"`g'q',.'of gaimblirib' I at this., - -i MAN
<br />''-'.: Far all a'reiai§ bbinb leased.f6r the condu6t
<br />-.of gambling'and' 'pr6duict' Nal
<br />"remises; iketdfi`(dr��N6) sh6wing'.1; 'the
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<br />Momp I e I 0affi-TSn,v6-c@ff6-ft, o--WPr0-VId0W Ketch 4
<br />rea(s;),�'and (2) tiie dirfiensions.i,
<br />feet by eet square feet.`'
<br />'Th6 leased areas'are:,;"I f for a't)o*t*a'l 'of, f
<br />square
<br />.t -j- -feet.N---.
<br />�j by
<br />feet fora "�l f total
<br />feet fog
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<br />et by
<br />sip.
<br />quarefeet" f fotal of
<br />p
<br />-,Storage,.- feet by eet for a total'of V are feet-":-::
<br />sq
<br />V;If
<br />'a total of quare fe"et - Stor,ag e feet by., feet for o
<br />square feet.
<br />- 1.
<br />Combined total f
<br />:j..
<br />MW;
<br />L 'a Wf u I Gambling Activity
<br />of Type ambling activity that.will be conducted at this gambling premises., Check all that apply,
<br />Raffles, Pull -Tabs --
<br />Paddlewheels _Tipboards
<br />Term ,of Lease .,.,: .,, . . —
<br />Amended Lease Only e 'of this lease agreement will be con' If this is showing changes occurring dur-
<br />�" P. current with the an amended lease
<br />rem!:, es permit issued by the Gambling Control Board,- Ing the teTj.of the' c rrent premises' permit,.' write. in the' 16s _ n e -9 . -
<br />6n termi 'ated'sobride bk"'rhbtual'bonseint ofthe'l 6s:6r ldat�'thiaii th&iiii66ii will be effective e.
<br />and lessee.' Both parti&s* that sigribd the lease must initial and date all
<br />changes.,
<br />Questions on . this orm shou d.be" he informatioh requested rm* used
<br />f I ' directed to the Licensing T req t6d on this".fo ' will be " by.the
<br />S6-6tio*ii-of, th'e�'-Ga'mbli'ng`Control Board at'(612) 6394000.-.". Gambling Control Board (Board) to determine your compliance
<br />This—public-aUo'n will bb'madQ available in alternative- format 4.-."with Minnesbta� statutes and rules governing lawful gambling
<br />Iarbe:'rint;.BraiII6)-'upon. request: Hearing impaired .�, activitles.7 All of the information that yodsupply'on this form
<br />individuals using a TTY may call the Minnesota Relay Service will becom6 public information when received by the Board
<br />at:1-800-627-3529 and ask to place 6 call to (612) 639-4000.'� except, if required, your Social Security number, which remains.
<br />private:
<br />nva e.,
<br />Page I of 2
<br />Rev. 8/97
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