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

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Minnesota Lawful Gambling LG215 Lease for Lawful Gamblin Check applicable item: _ 1. Leasefor new application. Subm\twith new premises permit application. ;;(',2. Renewed lease. Submilwith premises permit renewal. _ 3. New owner. Submit new or amended lease within 1 0 days after new lessor assumes ownership. Date effective I 1 _4. Amended lease -- . Checkthechange(s}lnthelease: _Rent _premises name _Boothlbar _Activilychange _Other Date that changes will be effective { I . Both partiesmustinitialanddateallchange-S:--- . Submitchan esatleast10da rlortothechan e. Organization name License number club 0> #;7:'" 5/06 Page1of2 Street address tJl:W:J Ghy State MN Zip Daytime phone ~fJ s? Daytime phone '1" ? -16r;t: Daytime phone , OMJ Name of leased remises \)c''''t-'f'I^orvfJJ ..G a"'+~ a...-,.,.... 1-:1 ( Name of legal owner of premises 75,0 ffw II? ",.v Businesslstreetaddress L0 yo:! Zip '2 3 -5::>6 Daytime phone '/9-6 ameoflessor(ifsameaslegal owner, write in "SAME") f)/d-m""d. S ork tJ ' (; y-57 -)&70 ~7ck all activities that will be conducted: )(..Pull~tabS _PuU-tabswith dispensing device _1ipboards _psddlewheel _Paddlewheel with table _Bingo _Barbingo Pull-tab, Tipboard, and Paddlewheel Rent (No lease required for raffles.) Booth operation' sales of gambling equipment by an employee Bilr operation. sales of gambling equipment within a leased (or volunteer) of a licensed organi<:ation within a separate enclosure premises by an employee of the lessor from a common area where thatlsdistindfrom areas where food and beVerages are sold. food and beYerages are also soid. r____________________________________i Does your organization OR any other organi7 conduct gambling from a booth operation at this location? Yes _ No L_________________ ___ ______________J If you an5'J\lered yes to the question above, rent limits are If you answered no tothe question above, rent limits are based on the following combinations of operation: based on the following combinations of operation: Booth operation Bar operation Booth operation and pull-tab dispensing device Bar operation with pUll-tab dispensingdevlce Booth operation and bar operation Pull-tab dispensing device only Booth ope:ation, bar operation, and pUll-tab dispensing device The maximum rent allowed may not exceed $1,750 in total per month for all organizations at thIs premises. complete one option: Option A: Oto10%qft;h~ssprofitspermonth. Percentage to be paid 1c.L-- % 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% of the gross profits may be paid per month on gross profits over$4,OOO. Percentagetobepaid % The maximum rent allowed may not exceed $2,500 in total per month for an organizations at this premises. Complete one option: option A: 0 to 20% of the graSS profits per month. Percentage to be paid % 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 $1,000 of gross profits. Amounttobepaid$ . PlusO%to 20% of the gross profits may be paid per month on gross profits crYer '$1,000, Percentage to be pa\d %, Bingo Rent Option 0: 0 to 10% of the gross profits per month from all lawful gambling activities held during bingo occasions, exduding barbingo. Percentage to be paid % option E: A rate based on a cost per square foot notto exceed 110% ofa comparable cost per square foot for leased space, as approved by the directOr of the Gambling COntrol BoZlrd. No rent may be paid for bar bingo. Rate to be paid $ per square foot The lessor must attach dOOJmentation, ver'ifiedbythe organization, to confirm the comparable rate and all applicable coststo be paid by the organization to the lessor. Bar Bingo Rent _option F: No rent maybe paid forbingo conducted in a bar. New Bingo Activity For any new bingo activity not previously 1ndu6ed 1n a Premises ?erm\tApp\\cation, attach a separate sheet of paper listing the days and Dours that bingo will be conducted. -59-