Agenda - Council - 02/24/2004 - Laserfiche WebLink

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Minnesota Lawful,Gambling LG215 LeaSe for Lawful Gambling ActiVity 8/03 Page 1 of Name of legal owner of p~emises Street address Nan~e.~i-iessor I - '" Street address (if same as legal owner, write in "SAME") - p Street address qame of lessee (organization leasing the premises) City State Zip Daytime phone · ' City ' hq. ate Zip ay~me pnone City Zip ~aytime phone Organization license numlJer ~aytime phone Rent Information (for activi~ involving pull-tabs, tipboards, paddlewheels, and pull-tab dispensing devices. No lease required for raffles.)' Booth operatio~ - ~ales or gambling equipment by an employee (or Bar operation - sales of gambling equipment within a leased volunteer) of a Ilcened organization within a separate enclosure that is premises by an employee of the lessor from a common area where distinct from areas v~here fOOd and beverages are sold. food and beverages are also sold. - ., Does your organization OR any other organization conduct gambling from a booth operation at this location? ~ Yes ~ No ~ If you answered yl~$ to the question above, rent limits are based on the following combinations of operation: Booth operation: Booth operation and pull-tab dispensing device Booth operation rand bar operation Booth operation, bar operation, and pull-tab dispensing device The maximum rent allowed may not exceed $1,750 in total per montl~ forall organizations at this premises· :omplete one option: Option A: 0 to [0% of the gross profits per month, Percentage to be paid __% Option B: When gross profits are $4,000 or less per month, $0 to $400 per month ma'~, be paid. Amount to be paid $ Option C: $0 to $400 per month may be paid on the first $4,000 of gross profit. Amo~Jnt to be paid $ Plus 0% to 10% of the gross profits may be paid per month on gross profits over $4,000. Percehtage to be paid % NOTE: If there · any 6ther terms or conditions for rent-related If you answered I~lO to the question above, rent limits are based on the following combinations of operation: - Bar operation Bar operation with pull-tab dispensing device Pull-tab dispensing device only The maximum rent allowed may not exceed $2;'000 in · total per month for all organizations at this premises. Complete one option: Option A: 0 to 20% of the gross profits per month. Percentage to be paid % Option B: When gross profits are $1,000 or less per month, $0 to $200 per month may be paid. Amount to be paid $. Option C: $0 to $200 per month may be paid on the first $1.,000 of gross profits. Amount to be paid.$ Plus 0% to 20% of the gross profits may be paid per month on'~jross profits over $1,000. Percentage to be paid __% Check all activities that will be conducted: expenses, they mu~t be identified on page 2 under Acknowledgment of Lease Terms and?re su~bject to Board approval ,__~_Pull-tabs ___Tipboards Pull-tabs with dispensing device Paddlewheel __Paddlewheel with table Rent Information: Bingo and/or Barr Bingo Occasions Rent for bingo and all other gambling activities conducted durirlg ~ bingo occasion may not exceed: · $200 per occasion for up to 6,000 square feet · $300 per ocr_,~sion for up to 12,000 square feet · $400 per occasion for more than 12,000 square feet · $25 per occasion for bar bingo conducted at any time in a bar (regardless of square footage). Your organization must conduct'another form of lawful gambling, and the premises muSt serve intoxicating liquor or 3.2 percent malt beverages. Rent to be paid per bingo occasion $ ~00, (J D Bingo Noon Hour Bingo Occasions Rent may not exceed $25 per da'/for noon hour bingo conducted between ll a.m. and 2 p.m. at a premises with a license for the sale of intoxicating beverages on the premises. Rent to be paid per bingo occasion $. For any new bingo activity not previously included in a Premises Permit Application, attach a separate sheet of paper listing the days and hours that bingo will be conducted, d Amended Lease Only [f this is an amended lease showing changes occurring during the term of the current premises permit, both parties that ~lgned the lease must initial and date all changes. Changes must be submitted to the Gambling Control Board at leiast 10 days prior to the change. Write in the date that the changes will be effective Lessor I Date __ Organization Date