Agenda - Council - 10/09/2007 - Laserfiche WebLink

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Check applicable item: _ 'Lease for new application. Submit with new premises permit application. 1 Renewed lease. Submit with premises permit renewal. 3. New owner. Effective date __ / Submit new or amended lease within 10 days after new lessor assumes ownership. _ Amended lease • Check the change(s) in the lease: name _Booth /bar Activity change Other _Rent _ Premises • Date that changes will be effective /_/ • Both parties must initial and date all changes. • Submit changes at least 10 days before the effective date of the change. Organization name C t- Mf f �) License number 00- -o'2 - /05 Daytime oho, 7�- Name of leased premises 1Pt4•�eS7 Street address /a PO I f z )Y /0 City / `(156 State AIN Zip 5 Daytime phone Name of legal owner of premises 1 \re. Q /3i`a11P Business /street address (,LC . City State Zip Daytime phone Name of lessor (if same as legal owner, write in "SAME ") ' Business /street address City State Zip Daytime phone Check (V) all activities that will be conducted NJ - tabs _Pull-tabs with dispensing device _Tipbbards VPaddlewheel _Paddlewheel with table _Bingo V Bar bingo Pull -tab, Tipboard, and Paddlewheel Rent (No lease required for raffles.) Booth operation - sales of gambling equipment by an employee Bar operation - sales of gambling equipment within a leased (or volunteer) of a licensed organization within a separate enclosure premises by an employee of the lessor from a common area where that is distinct from areas where food and beverages are sold. food and beverages are also sold. r Does an OR our organization y g any other o rganiz tioR conduct gambling from a booth operation at this location? i Yes No L If you answered yes to the question above, rent limits are based on the following combinations of operation: - Booth operation - Booth operation and pull -tab dispensing device - Booth operation and bar operation - Booth operation, 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: 0 to 10% of the gross profits per month. Percentage to be paid % J If you answered no to the question above, rent limits are based on the following combinations of operation: - Bar operation - Bar operation with pull -tab dispensing device - Pull -tab dispensing device only 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. Percentage to be paid % Option B: When gross profits are $4,000 or less per month, $0 to $400 per month may be paid. Amount to be paid $ . Option B: When gross profits are $1,000 or less per month, $0 to $200 per month may be paid. Amount to be paid $ . Option C: $0 to $400 per month irst $4,000 of gross o profit. Amount to be paid $ Option C: $0 to $200 per month on the first $1,000 of gross profits. Amount to be paid $ . , Plus, 0% to 10% of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid /Q % Plus, 0% to 20% of the gross profits may be paid per month on gross profits over $1,000. Percentage to be paid % • Bingo Re I Bar Bingo Rent -- Option D:- Oto -10% ofthe-gross profits per month from all lawful- gambling activities held during bingo occasions, excluding bar bingo. Percentage to be paid % j - ption F tVo rent may be paid for bingo conducted in a bar. Option E: A rate based on a cost per square foot, not to exceed 110% of a comparable cost per square foot for leased space, as approved by the director of the Gambling Control Board. No rent may be paid for bar bingo. Rate to be paid $ per square foot. New Bingo Activity For any new bingo activity not previously included in a Premises PermitApplication, attach a separate sheet of paper listing the days and hours that bingo will be conducted. The lessor must attach documentation, verified by the organization, to confirm the comparable rate and all applicable costs to be paid by the organization to the lessor. Minnesota Lawful Gambling LG215 Lease for Lawful Gambling Activi 6/07 Page 1 of 2 -65-