Agenda - Council - 03/22/2005 - Laserfiche WebLink

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Minnesota Lawful Gambling ' , ~ ~ LG215 Lease for Lawful GamblingACtivity Name of legal ownerof premises Business~f~treet address ~ iCity Name of dssor ll/Oq Page 1 of 2 State Zip S~ate Zip Daytime phone Business~treet address ' !City Daytime phone (If same as legal owner, write in "SAME") r Name of leased premises ~treet ad~Ee~ rC~ Zip D~ime phone ¢Organbation li~nse ~mber ~ame 9f lessee (organization leasin~the premise~) Da~ime phone -r Rent (for a~ivi~ involving pull-tabs, ~pboards,~ paddleWhe~Is, and pull-tab dispensing devices. No lease required for raffles.) Booth operation - safes of gambling equipment by an empl~ee (or Bar operation - ~ales of gambling equipment wi~in a leased volunteer) of a licensed organization within a separa~ enclosure ~at is ~ prom sos by an employee of ~e le~r from a common area where dis~n~ from areas where food and ~verages are sold. : ' '~ food and bevera~ are al~ sold. Does '/our organization OR any ot~r organiza~o~condu~ gambling from a booth~SperaUon at ~is I~tion? ~ Yes No Booth opemUon T B~e~a~ion Booth o~a~ion and pull-~b dispensing d~vi~ ~ - Ba~ op~a~ion ~i~ pull-~ab di~pen~ng devi~ Booth ope~Uon and ba~ o~e~aUon Rull-~ab di~en~ng d~vice only Booth o~era~ion, ba~ oHe~a~ion~ and pulF~ab dispensing ~e maximum ~en~ allo~d may no~ ex~e~ ~e Ii~i~ ~e maximum mn~ ~llo~ed m~y no~ exc~d ~he Iimi~ established unde~ Minnesota S~a~u~e 3~9. ~ Su~. ~(b)~)~ ~abli~h~d und~ Minnesota S~a~e S~9.~8~ Subd. ~(b)(~). :omplete one option: COmplete one option: Option A: 0 to 10% of the gross profits per moqth. .Option A: 0 to 20% of ~e gross profi~ per mon~. Percentage to be paid / ~ % P~centageto be paid % Option B: When gross profi~ are $4,000 or less pe~ mon~, $0 to Option B: When gro~ profi~ are $1,000 or less per month, $0 to $400 per month may be paid. Amount to be paid $ ~ < . $200 per mon~ may be paid. Amount to be paid Option C: $0 to $400 per month may be paid o~ ~e fir~ ~,00b O~tion c: $0 to $200 per month may be paid on ~e fir~ $~,000 of gross profit. Amount to be paid $. Plus0°/oto o(gro~profi~. Amount to be paid $. . Plus0%to 10% of the gross profits may be paid per month on ~rosS profi~ 20% of ~e gro~ profi~ may be paid per month on gro% profi~ over $4,000. Percentage to be paid o/~: ' over $~,000. Percentage to be paid % Check all activities that will be conducta~=~ ~Pull-tabs Pull-tabs with disp~nsing dg~ce ~pboards~ ' Paddlewheel Paddlewheel with table :Rent Information: Bingo Bingo and/or Bar Bingo Occasions Rent for bingo and all other gambling actiVin% ~ Noon Hour Bingo Occasions conducted during a bingo occasion may n~'exce~: ; Ren~ may not exceed $25 per day for noon hour · $200 per occasion for up to 6,000 square feet : : bingo conduced be~een [[ a.m. and 2 p.m. at a · $300 per occasion for up to [2,000 squere feet : premises with a licen~ for the ~le of intoxicating · $400 per occasion for more than [2,00~ ~uare fee~ beverages on the premises. · $25 per occasion for bar bingo conduced at any time in a Rent to be paid per bingo ~si~n bar (regardless of square f~tage). You~ organizaBon mu~ condu~ another form of la~ul g~mbling, and ~e. F For any new bingo a~ivi~ not previously premises must se~e intoxi~ting liquor:Or 3.2 per~nt : i [ includedin a Premises PermitApplication, malt beverages. :; : [ a~ach a separate sheet of paper listing the ' : days and houm that bingo will be conduced. Rent to be paid per bingo occasion $. L ~ ~ If ~is is an amended lease sho~ng~ang~ oC~ng ddfing ~e te~ of ~e ~ent premi~ ~it, ~ pa~ Amended ~at sign~ ~e lea~ mu~ ini0al a~ da~ al[~ng~: ~nges mu~ ~ submiE~ to ~e Gambling Con~ol ~ard Lease at least ~0 days prior to ~e chaqGe. Write,in.the da~e ~at ~e ~anges will be eff~ve ~ / O n ly L~r Date OrganizaOon Date