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MINNESOTA LAWFUL GAMBLING <br />LG230 Application to Conduct Off -Site Gambling <br />. . . . . . . . . . <br />bRGANIZATI . .. ... ... ..... . . .... <br />0N'TN.F0RMAT-..10W.;' <br />Organization Name. Li cn tt 6 License Number: 6 <br />I Address:P4) -771 <br />City: Aq�C , MN Zip: <br />Twelve off -site events are allowed each calendar year not to exceed a total of 36 days. <br />q g *f 42 <br />From to q I <br />Check the type of games that will be conducted: <br />Raffle E Pull -Tabs Bingo LKTipboards Paddlewheel <br />Does your organization own the gambling premises? <br />Yes If yes, a lease is not required. <br />6/15 Page 1 of 2 <br />No Fee <br />55303 <br />L' )QNo If no, the lease agreement below must be completed., and signed by the lessor. <br />...... . ..... <br />SITE. At'T`INXTa- te.men s not: rq <br />pireA for raM e <br />s <br />� Rent to be paid for the leased area: $ <br />(if none, write "011) <br />All obligations and agreements between the organization and the lessor are listed below or attached. <br />0 Any attachments must be dated and signed by both the lessor and lessee. <br />@ This lease and any attachments is the total and only agreement between the lessor and the organization conducting lawful <br />gambling activities. <br />* Other terms, if any: <br />Lessor's Signature: <br />Print Lessor's Name: <br />CONTINUE TO PAGE 2 <br />Date: <br />