Agenda - Council - 12/14/1999 - Laserfiche WebLink

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' I Minnesota Lawful Gambling Lease for Puli-Tab, Paddlewheel, Tipboard, and/or Raffle Activi - LG221 I ~la.me of Legal Owner of Premises Street Address City __ Zip Daytime Phone Name of Lessor Street Address ' City Zip Daytime Phone (if same as legal owner, write in "SAME") ..... ~,.-~.~). Name of Leased Premises Street Address City ' ~ Zip / Daytime Phone. Name of Lessee (nar~e of organization leasing the premises) GCB license no. of orga/nizationDaytime Phone b z/f - .. I i~ent In'formation Total rent cannot exceed $1,000 per month for all · An organization may not pay rent to itself or to I non-bingo activity for this premises, any of its affiliates for space used for the conduct : For bingo activity, use lease form LG222. of lawful gambling. For pull-tab dispensing machines, use lease form r~ I LG223. J Rent to be paid per month $ J (If no rent is to be paid, indicate.43-) Sketch and Dimensions of Leased Area Sketch: For all areas being leased for the conduct of gambling and storage of gambling product at this premises, attach a sketch (drawing) showing: (1) the leased area(s), and (2) the dimensions. Dimensions The leased areas are:. Storage Storage . feet by feet by feet by feet by feet by Lawful Gambling Activity // feet for a total of 05 square feet. feet for a total of square feet. feet for a total of square feet. feet for a total of square feet. feet for a total of square feet. Combined total square feet. , i Type of gambling activity that will be conducted at this gambling premises. Check all that apply. ~ Paddlewheels ~ Puli-Tabs- ~ Raffles.. ~ Tipboards Term of Lease Amended Lease Only ,. The term of this lease agreement will be concurrent with the premises permit issued by the Gambling Control Board, unless terminated sooner by mutual consent of the lessor and lessee, If this is an amended lease sho~ving changes occur- ring during the term of the current premises permit, write in the date that the changes will be effective __1__1 . Both parties that signed the lease must initial and date all changes. Questions on this form should be directed to the Licensing Section of the Gambling Control Board (Board) at 651-639- 4000. This publication will be made available in alternative format (i.e. large print, Braille) upon request. Hearing impaired individuals using a TrY may call the Minnesota Relay Service at 1-800-627-3529 and ask to place a call to 651-639-4000. The information requested on this form will become public information when received by the Board. and will be used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities. Page 1 of 2 1/99