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Minnesota Lawful Gambling
<br />LG215 Lease for Lawful Gai.,mbli:ng ACtivity
<br /> Name o~'egal .:',vner ct'premises 8usinesSlSjr'eet ~ddre$~, :: 1 4.t-1
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<br /> Name of'asset Eiusiness/s,Cr~et addresS' ' : C.tt
<br /> (ff same as '.e,3.~i owner, write ;n 'SA,ME")
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<br />Name of ]eased premises $1reet address
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<br />Page 1 of 2
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<br />~:~:e Z!p Day~Jm, e phcne
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<br />~,~:e Z!p Daytime phone
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<br />Daytime phone
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<br />Organizat!~n license number
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<br />Nam?,)o f !essee (organization Jeasing the premi§e.~) Daytime phone
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<br /> : Rent'lnformation
<br /> (,'or actlv!b/ involving ;ull-tabs, tipbcards, pa~d'.ewheels, and pull-~ab disce~s;~G devices. No ',ease required for
<br />Booth opera[ion - sa~s of gambling e~ui¢ment by a¢ ~m¢;cy~e (er ~Bar operation - sa:es =f Gambling equipmen~ ,Mbhin a leased
<br />voice:ear) ~¢ a :icensed organization wibhin a separate.endc~r~ ~t i~ ~r~mises by an employee cf %-e ~e%~r ffcm a ccmmcn area ~',her~
<br />dis~ from areas where fccd and beverages are ~cld. fccd and bev.r_~ ~r~ af~ sold.
<br /> Does your organization OR a~Y othe~ organiza~n condu~ gambling
<br /> from a booth operation: . at,this: .. lo'~Uon?., ,~ Yes No
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<br />! I~'You answered rio to bhe queAion above, rent limits are
<br />r, CaSed on the fcllo~ing combinations of operat~cn:
<br /> iBar cperation
<br /> Bar cperaticn with p,ull-tab dispensing de,/ce
<br />- 'Pull-tab dispensing de,,ice only
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<br /> ;The maximum rent ailcwed may not exc~d [,he limi~
<br /> :e~abiished under Minnescta Statute 349.!8, Sub& l(b)(4).
<br /> iT'ne limit as of May 1, 2004. is $2,500 in total per month
<br /> :for all organizations at ~is premises.
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<br />Complete one option:
<br />Option A: 0 to 20% of the gross profi~ per month.
<br />Percentage to be paid %
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<br />If you answered yes to the question above, rent Iimi~ are
<br />based on the following combina~cns of operafdon: Bcoth operaEcn
<br /> Bcoth operation and pull-tab dispensing device
<br /> Booth operat:on and bar operation
<br /> Booth cFerat!cn, bar operation, and pull-tab dispens;r.g device
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<br /> The maximum rent allowed ma./net exceed I~e.;imi~
<br /> established under Minnesota $~atute 349.18, ~ubd. 1(b)(4).
<br /> The limit as of May 1, 2004 is $!,750 in total per mpnth
<br /> for all organizations at this premises.
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<br />:omplete one option:
<br />Option A: 0 to 10% of the gross pro,ts per month.
<br />Percentage to be paid .//-P % : :
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<br />Option B: When gross profits are $4,000 or less per rr. onb%, $0 to
<br />$400 per mcnth may l:e paid. Amount to be paid $;; .
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<br />Option C: SO r.o 5400 per mcn[h may be paid on d~.e fi.=--~ $4,000
<br />of gross prot~t. Amount to be paid S : i. Flus 0%:tO
<br />10% of the gross profits may be paid per month on GroSS profi.ts
<br />over $4,000. Percentage to be paid % : :
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<br />Option B: When grc~ prc¢,,~ are $!,000 or less per month, $0 to
<br />$200 per mcn~n ma'/be ;e!d. Amount to be paid $.
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<br />Option C; $0 ~o -2200 per .m. cnth may be F-aid on the fir~ $I,000
<br />of(~rcss profits. Amount to be paid -2 . Plus 0% to
<br />20% of ~e gross profits may be paid per month on gross profits
<br />over $1,000. Percentage to be paid __%
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<br />:~pCk all activities thatwill be conducted: '
<br /> ull-tabs Pull-tabs"Mth dispensing device Tipboards Paddlewheel Paddlewheel with table
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<br /> Rent InfOrmati,
<br />Bingo and/or Bar Bingo Occasions
<br />Rent for bingo and all other gambling activities
<br />conducted dur!ng a bingo cccasion may not exceed.:
<br /> · $200 per occasion for up to 6,000 square· feet
<br /> · $300 per cc:asian for up to t2,000 square feet
<br /> · $4C0 For cccasion for more than 12,000 rSqUare feel:
<br /> · $25 per occasion for bar bingo conducted at any time in a
<br /> bar (regardless of square fcotage). Your organizald0n ::
<br /> must ccnduct another form of lawful gambling, and the
<br /> premises must sep/e intoxicating liquor or 3.2 percent :
<br /> mall: beverages.
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<br />Rent to be paid
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<br />per bingo occasion $
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<br />Amended
<br />Lease
<br />Only
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<br />I-
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<br />~n: Bingo
<br /> Noon Hour Bingo Occasions
<br /> Rent may not exceed $25 per day for noon hour
<br /> bingo conduced bob,yeah 11 a.m. and 2 p.m. at a
<br /> premises with a license for the ~!e of intoxicaUng
<br /> beverages cn the premises.
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<br /> Rent to be paid per bingo occasion $
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<br /> For any new bingo activity not previously
<br /> included in a Premises Permit Application, J
<br /> attach a separate sheet of paper listing the I
<br /> days and hours that bingo will be conducted,
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<br />If ~,s is an amended lease showing ~.ar~es ccCUning during the term cf the c.;rrent premises permit, both par'des
<br />that signed the lease must initial and da~ allchahges, changes mu~ .be submi~ed to the Gambling Control Board
<br />at least ~.0 days prior to bh.e change, Write in the date that the changes 'Mil ~ eff.~-'.dve / /.~
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<br />Les~r Date __ Organization Date
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