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Minnesota Lawful Gambling ~
<br />LG215 Lease for Lawful Garnbling Activity
<br /> Name of ;ega[ Jwper cf pKemJses Business/$(~'~et ad~re~-4 i¢J~/
<br />
<br />Name cf :esscr Business/$(raet address C.tl
<br />(if s~,TCte as !eg.~i Jwr:er. write in "SA,YE")
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<br />Page 1 of 2
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<br /> Name of '.eased p(emises Street address Cb/ Z~p Daytime phone
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<br /> Na~e of ',essee (organization leasing the premises~ ; : Or-;~n~at!cn !i~nse number Da,~ime
<br />
<br /> Rent lnformation
<br /> (fur a~w~/ ir. vcMng pull-tabs, tipbcards, Padd[e..~'heels, and Pull-tab dispensing devices. No ~ease required for ~Mes.)
<br /> Booth operation - safes of gambling e~uipm'ent by an em;~cyee (Qr ~ar operation - sa!es cf
<br /> volunteer) cf a '!cer~ organization within a separate optics;re ~at is ~rem;~s by an employee =f %to '.e%~r from a common area ',',here
<br /> d~s¢c~ from areas .vhere fccd and beverages are sold; ' ;fccd ~nd .ev.._~ are al~
<br /> Does your organizatio~ OR amy other organization condu~ gambling
<br /> from a booth o~eraUom at t~if lo~don? ~ Yes ~ No
<br />If you ans,~ered yes to the que~ion above, rent iimi~ are I~Ybu an~,vered ~O to ~e quePdon above, rent limi~ are
<br />based cn the fcllc,,,Ang combina~ons of operaDon: : ba~ cc ~e fcllo~ng ccmbina~ons of oFeraDon:
<br /> Booth o¢4~cn - ~rcFeration
<br /> Bcoth operadcn and pull-tab dispensing device Bar cOed:ion wiW pu~l-Wb dispensing device
<br /> Booth opere~cn and bar operaUon ; FdI-Wb dispensing device only
<br /> Booth operation, bar o;eratlcn, and pull-tab dispens:,no device
<br />
<br /> %ge me,mum rent allowed may not exceed We
<br /> established under Ninnesota Statute 349.18, Subd. 1(b)(4).
<br /> %ne limit es cf ,Hay 1, 2004 is $1,750 in total per mcnW
<br /> for all organizations at this premises.
<br />
<br /> :omplete one option:
<br />Option A: 0 to 10% of the gross profits per mon~.
<br />Percentage to be paid /0
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<br />Option B: When gross profi~ are $4,000 or less ~r mcnW, $8 to
<br />546.0 per month may be paid. Amount to be paid $] ~.
<br />Option C; 50 to 5400 per monW may be paid on we 2~ ~,000
<br />cf gross pro~t. Amount to be paid S . P;us 0% to
<br />10% of the gross profits may be paid per month on grc~ ProfiW
<br />cver ~4,000. Percentage to be paid %
<br /> Check alt activities that will be Conducted: r
<br />
<br /> ~Puml-tebs PumFtabs with dispensing de~e ~pbOards : ~P~ddlewheel ~Peddlewheel ,Mth teble
<br /> nt InformatiOn: Bingo
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<br />Bingo and/or Bar Bingo Occasions
<br />Rent far bingo and all other gambling actMUeS
<br />conducted dur;.ng a bingo occasion may not exceed:
<br /> , $200 ¢er cccasion for up to 6,000 square: fe~t
<br /> · .~300 per co,sion fcr up to 112,000 square feet
<br /> · 5400 per occasion for more Wan t2,000 square feet
<br /> · C ....cn
<br /> $25 per r,-*~i for bar bingo conducted at any time in a
<br /> bar (regardless of square footage). Your organizaUon
<br /> must cc¢.duct another form of lawful gem.hilt, g, and the
<br /> premises must sense intoxicating liquor or 3.2 percer~t:
<br /> malt beverages.
<br />Rent to be paid per bingo occasion $. :
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<br />Amended
<br />Lease
<br />Only
<br />
<br /> The ,maximum rent allcwed may nc: exceed the limits
<br /> estabiished under Ninnesota Sta~te 349.18, Subd. !(b)(4).
<br /> ,The ':imit as cf Hay 1, 2004 is $2,500 in total per month
<br /> ifcr ail crc. anizaUons at Wis premises.
<br />
<br />complete one option:
<br />Op[ion A: 0 to 20% of the gross profits per month.
<br />Percentage to be paid
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<br />Op_ldon B: When gross 2rot]ts are SZ,000 or less per rochE% $0 to
<br />$20'0 car mcn~q may be ;aid. Amount to be paid S ,
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<br />Opl:Jon C: $0 to ¢200 per mcn5n may be paid on the t]r~ $~.,000
<br />of*prs~.:r;C, ts. Amount to be paid S . Plus 0% to
<br />20% of the gross profits may be paid Far month on gross profits
<br />o'~er S:,O00. Percentage to be paid
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<br /> Noon Hour Bingo Occasions
<br /> Rent may not exceed $25 per day for noon hour
<br /> bin_co conducted between ).~ a.m. and 2 p.m. at a
<br /> premises with a licen~ for the sale of intoxicating
<br /> beverages on the premises.
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<br /> Rent to be paid per bingo cccasion$
<br />
<br />' For any new bingo activity not previously
<br />J included in a Premises Portal:Application, J
<br />j attach a separate sheet of paper listing the j
<br />days and hours that bingo will be conducted,
<br />L ~-J
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<br />If ~,~s ~s an amended lease showing r~ar. ges Occurring dudr. g .~,e term of bhe c~,;rrent premises permit, both par'des
<br />Lha( signed ~,e lease must initial and date all charigeS. Chang'es mu~ be submitted ~.o ~:e Gambling Control Board
<br />at least J.O days prior to the changre. Write in the date th. athhechanges'¢~llbeeffeC, dve / / .
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<br />Le~scr Date OrganizaUcn Date
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