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Minnesota Lawful Gambling LG224 Lease for Off-Site Gambling Activity sim Name of legalowner of property Street address City Slate Zip Daytime hone Nameo lessor (if same as legal Street addres City Slate Zip Day/time pho e owner, write in "SAME") ~S'/~ 7~~ - ~Qa 9 ~~~ Name of leased premises Street address, or road designations City Zip Daytime phone Name of lessee (organization) Orga ization license number Daytime phone Gambling Activity 1. Beginning date of off-site activity ~3~ ® Ending date of off site activity ~ ~ ~ 2. Check ('~) the type of gambling activity that will be conducted for this off-site activity. pull-tabs _ bingo _ tipboards _ paddlewheels (No lease is required for raffles) --- --- ----------- -- _ _ _ __ _ _ ---_ __-- -- ---- l Lease Obligations ___ 1. Rent to be paid for the leased area $ ~_ If none, write "0." 2. All obligations and agreements between the organization and the lessor are listed below or attached to this lease. Any attachments to this lease must be dated and signed by both the lessor and lessee. This lease (and any attachments) is the total and only agreement between the lessor and the organization conducting lawful gambling activities. Other terms ~~.,~ X009 .~6,0 0 Sig lure of lessor ,,~~ ate lure of orgrz io_off'ic/al (lessee) Date t/O~~ ~~l~~soD~ ~~/~?D/~/,d ~/l~ilb~ Print name of lessor Print name and title of person signing on behalf of organization This publication will be made available in alternative format (i.e. large print, Braille) upon request. ~7 The informaiion 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.