Agenda - Council - 10/25/2005 - Laserfiche WebLink

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Minnesota Lawful Gambling 81o5 LG215 Lease for Lawful Gambtin,g Activity Page Organ~zationna~e ..... License number .... [~aytime phone Name of leased premises j Street a~dre~ C~ State ~ Zip ' ' ~ephone Name or lega~ owner ofpmmises Businessmtreet~d~¢~ C~ Slat~. Zip " ' Ba~ime phone N~me ofles~r (if s~8 ts legit 8usines~street addre~ Ci~ S~te j ZJp. Da~ime phone owner, ~ite in "SAME") ~ ,x Checkall a~ivities thatwill be conduced: / Puil-~b, ~pboard, and Paddlewheel Rent ( No ~.as~ requir~ for Booth operation - sales o~ gambling equipmen~ by an employee Bar ogem[ion - sales of gambling equlpmen~wi~in a leased (or volun~er) of a {lcensed organization w~in a sepa~Le enclosure prem~.by an employee ot ~e lessor ~om a common area where tha~ ~ dis~n~ Crom ar~5 where ~ood and beverag~ are so~. food and beverages are also sold. C ........ Does your organ~a~o~ OR any e~her organJza?~ conduct gambling I from a booth o~r~on at thia Io~fion? ~ Yes ~ No if you angered ye~ ~o ~e ques~on above, ren~ limi~ are if you an~red no to ~e que~on above, ren~ limi~ are ba~d on ~he ~lto~ng combina~ons of open,on: based on ~e ~llo~ng combina~ons o~ ope~fion: Boo~ ope~fion Bar opera,on Boo~ opera,on and pull-~b dispensing device Baropera~on ~ pull-~b dispensing device Boo~ open,on and bar ope~on Pull-~b dispensing device only Beo~ open,on, bar open,on, and pull-~b dispensing device ~e maximum rent allowed may not exce~ $[,750 in to~l ~e maximum renL allo~d may not ~ceed $2,500 in ~t per month ~r ail organi~ons a~ ~ premises, per mon~ ~or all organizaQons at this premis~. Complete one option: ~mple~e one opUon: Option A: 0 to [0% of the gross profi~ per mon~. Option A; 0 ~o 20% of the gross profi~ per month. Percen~ge ~ be paid ~% Percen~ge ~o be paid Option B: When gross profiG are $~000 or less per men~, $0 te Option B: ~en gross pro~ are $ ~,000 or I~s per month, $~0 per men~ may be paia. Amoun~ co be paid $ ~o $200 per mon[h may be paid. Amoun[ ~ b~ paid $ OpfionC: $0~o $~0 permonth may be paid on ~e ~ $~,000 OpfionC: $O to $ 200 per month may be paid on ~e fi~ $[,000 oCgross profiL Amoun~to be paid $ ~, ~ Plus 0% ~o of gross pm~. Amoun~tobe paid $ . Plus [0% of ~e gross pro~ may be paid p~r mon~ on gross profi~ 20% o¢ ~e gross pro~ may be paid per mon~ on gross profi~ nver ~!)~. Percentag~ to be paid /~ % over $[,000. Percan~ge ~o be paid __% Bingo Rent (~mp[~t. Op~un D; 0 ~o [0% o~he gross profits per monLh ~om ell la~ul V Option F: Bar bingo only - No ren~ may be gambling ~vi~ heldduring bingo occasions, excluding barbingo, paid ~r bingo conduced in a bar. Percen~ge to be paid % O pfio n E: A ~e based en~ co~ per square ~ot no~ to exceed [ ~0% o[ a compa~ble co~ per square ~et for leased space, as approved by the dire~or of ~e Ga mbling ConSol Boa~. No rent may be paid for bar F For any new bingo a~v W not previously I bingo. Rate to be paid $~ per square ~ot, I includedin a Premises Permit~plica~on, The lessor mu~ aCach d~umen~on, verified by ~e organi~on, to ~ a~ch a separate sheet of paper listing the confirm ~e compa~bie ~te and all applicable co~ ~ be paid by ~e Ldags and hou~ ~at bingo will be conduced. or~ani~a~on m me lessor. If this is an amended lease sho~ng changes ~cu~Jng during ~e ~erm o~ ~he cu~ent premis~ permit, bo~ pa~es Amend~ that signed ~e lease mu~ ini~al and dale all changes. ~ang~ must be submi~ed ~o ~e Gambling Con~o[ Board Lease at least ~0 days prior to ~e change. WrZe in ~e da~e U~at ~e chang~ will be e~eCve /_ Only Lessor Dale ~ O~anization Date ?5' -114-