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CG 202(9/89) <br /> Lawful' Gamblt-g Le se Ag'recmcnt <br /> <br />Pl'¢I~d~ee Info~tton <br /> <br />Name cfi legaJ I~emi~es owner (lessor) <br /> <br />Name of eul:~e~or (it any) <br /> <br />Address C.,it~/Zlp Code Phone <br />Ack~lm~,~ P.,fl'y/--z. mp C_.ode Phone <br /> <br />Name and mddre~ o( leased prem~es , <br /> <br />Nm"ne ot o~~n ~m~ ~e wem~s (~e) <br /> <br />Addr~ C.2~y/Z3 p Code <br /> LJcenJe NumVer, ~ lr, r~:n~n <br /> <br />The lawful gambling activity which the organiz~on will conduct are (check all tha~ apply): <br /> ~ blr~o ~ raffles [~.pacldi4~vhe~ls ~ I~JIi-tJ~J~ ~ti~boards <br /> <br />Rent Tr~or'z33at~ozz (See Rules 7860.00g0, Subp 3) <br /> ~ A and C I~: <br /> Re~ for ~o and ~1 o~er ~Mi~ ~s ~nd~ <br /> du~ that ~o ~bn may ~t e~: <br /> $2~ for up to 6,~ ~u=e f~t; <br /> ~ ~r up to 12,~ ~e t~; ~ <br /> ~ ~r more ~ 12,~0 ~u~ feet. <br /> J R.~ ~ ~ ~ ~ ~o c<~n $ I IRentm ~ ~ ~ m~th <br /> ~ ~y ~t ~ ~ on a ~ge of r~lp~ ~ profl~ ~ ~1 gamblln~ <br /> <br /> Ca=.~ B and D llcen~es: <br />Rer~ for gambling a~tMti~ not including bingo <br />may not exceed $24 per squ~e focrt per month, <br />with a maodmum of <br /> <br />~e~eale~in~e ~em~es ~ f~t~ feet, forat~ ~ ~- , square feet. ' <br /> <br />~ a ~etch wh~h ~e~es ~e ~bn of the le~ premises when a ~bn of a bui~ing ~ the le~ premises. <br />~ ~e~ mu~ in~ude t~ dimensbns of the ~ ~emi~s. <br /> <br />T~mes and Days of BLugo Activity <br /> <br />The bir~o occ~ions wil~ be helcl: <br /> <br />from (hours) (a.m.Yp.m.) I= <br />from (hour) (a.m./p.m.) to <br />from (hours) (a.m./p.m.) to <br />from (hours) (a.m./p.m.) to <br />from (hours) (a_m./p.m,) to <br />from (hours). (a.m./p.m.) to <br /> <br />(If none, indicate WA) ~ N/A <br /> <br />(a. mJp.m.) on (days ot' week) <br />(a.m~.m.) on (days of week) <br />(s. mJp.m.) on (days of week) <br />(a. mJp.m.) on (days cf week) <br /> <br />- - ~' (daN of week) <br />( ..... ~.m.) on <br /> <br />(a.m./p.m.) on (days of week) <br /> <br />41 <br /> <br /> <br />