Agenda - Council - 04/10/2007 - Laserfiche WebLink

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Minnesota Lawful Gambling LG215 Lease for Lawful Gamblin Check applicable item: _ 1. Lease for new appll~t1on. Submit with new premises permit application. .k. 2. Renewed lease. Submilwith premises permit renewal. _ 3. New owner. Submit new or amended lease within 10 days after new lessor assumes ownership. Date effective -1_'_ 4. Amended lease . Checkthechange(s)inthelease; _Rei'll _Premises name _Boothlbar _Activity change _other Date that changes will be effective_'_'_ . SoUl ?artiesmust inmaland date an changes. . Submilchan esat!east10da s rlortothechan e. Org nizationname 5/05 Pagelof2 Ucensenumber Daytime phone U.:V^ C /" ~ ~/;lO3 -lSV-$S79- Streetaddress C"' Sla" Zip Daytime phone ~u",J 7"'> , sc; s::..m MN ,. -22-~ Businessfstreetaddress ISla~ Zip Daylimephone ,,~rf.~;', I"J 1-1" o~ >753 ~~q I Businesslstreetaddress Sla" Zip Daylimephone h k all activities thatwill be conducted: Pull-tabs _Putl-tabswlth dispensing device _TIpboards ~ddlewheel _Paddlewheel with table _Bingo _Bar bingo Pull-tab, Tipboard, and Paddlewheel Rent (No lease required for raffies.) Booth operation - sales of gambling equipment by an employee Bar operation - sales of gambling equipment within a leased (or volunteer) of a licensed organization wltl1ln a separate enclosure premises by an employee of the lessor from a common area where that is distinct from areas where food and beverages areso!d. food and beverages are alsoso!d. r------------------------------------, Does your organization OR any other org:aniZ~o nduct gambling from a booth operation at this location? Yes No ~--~-------------- ---- --==---------~ If you answered yes to the question above, rent limits are If you answered no to the question above, rent limits are based on the following combinations otoperation: based on the following combinations of operation: Booth operation Bar operation Booth operation and pull.tab dispensing device Bar operation with pull-tab dispensing device Booth operation and bar operation Pull-tab dispensing device only Booth operation, bar operation, and pUll-tab dispensing device The maximum rent allowed may not exceed $1,750 In total permonthforall organizations at this premises. COmplete one option: option A: 0 to 10% ofthWross profits per month. Percentage to be paId If) % Option B: When gross profits are $4,000 or less per month, $0 to $400 per month may be paid. Amountto be paid $ option C: $0 to $400 per month may be paid on the first $4,000 of gross profit Amount to be paid $ . Plus 0% to 10% oflhe gross profits may be paid per month on gross profits over $4,000. Percentage to be paid % Bingo Rent Option 0: Oto 10% of the gross profitspermonth from all lawful gambling activities held during bingo occasions, e.xduding bar bingo. Percentagetobepaid % option E: A rate based on a cost per square foot notto exceed 110% ota comparable cost per square foot for leased space, as approved by the director of the Gambling Control Board. No rent maybe paid for bar bingo. Rate to be paid $ . per square foot. The lessormustattachdocumentation, verified by the organization, to confirm the comparable rate and all applicable costs to be paid by the organizallontothelessor. The maximum rent allowed may not exceed $2,500 in total per month for all organizations at this premises. Complete one option: Option A: 0 to 20% of the gross profits per month. ?ercentagetobepa'ld % Option B: When gross profits are $1,000 or less per month, $0 to $200 per month may be paid. Amountto be paid $ Option C: $0 to $200 per month may be paid on the first $1,000 of gross profits. Amount to be paid $ . Plus 0% to 20% of the gross profits may be paid per month on gross profits over $1,000. Percentage to be paId % Bar Bingo Rent _ Option F: No rent may be paid for bingo conducted in a bar. New Bingo Activity For any new bingo activity not previously Induded In a Premises PermltApplication, attach a separatesheetofpaperlisting the days and hours that bingo will be conducted. -53-