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MINNESOTA LAWFUL GAMBLING <br />LG230 Application to Conduct Off -Site Gambling <br />6/15 Page 1 of 2 <br />No Fee <br />Organization Name: Little Canada Recreation Assoc, <br />Address: 515 Little Canada Rd <br />License Number: 34510 <br />City; Little Canada <br />, MN Zip: 55117 <br />Gambling Manager Name: Katie McGinnity Daytime Phone: 651-775-5993 <br />Chief Executive Officer (CEO) Name: Jon Joriman <br />Daytime Phone; 651-3244414 <br />Gl%RIBLING ACTIVITY <br />Twelve off-site events are allowed each calendar year not to exceed a total of 36 days. <br />From 02 / 06 / 201C,to 02 / 06 /201 <br />Check the type of games that will be conducted: <br />Raffle Pull -Tabs <br />Bingo <br />Tipboards <br />Paddlewheel <br />GAMBLING PREMISES <br />Name of location where gambling activity will be conducted; Gervias Beach <br />Street address and <br />City (or township): Edgerton & Little Canada Rd Little Canada <br />• Do not use a post office box. <br />• If no street address, write in road designations (example: 3 miles east of Hwy. 63 on County Road 42). <br />Does your organization own the gambling premises? <br />Yes If yes, a lease Is not required. <br />No If no, the lease agreement below must be completed, and signed by the lessor. <br />Zip: 55117 <br />County; Ramsey <br />LEA%S'E AGIlEEMENT FOR OFF—SITE ACTIVITY (a tease agreement is net refit:In-el:1 for raffles) <br />Rent to be paid for the leased area: $ 0 (If none, write "0") <br />All obligations and agreements between the organization and the lessor are listed below or attached. <br />• 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: Date: <br />Print Lessor's Name; <br />CONTINUE TO PAGE 2 <br />