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i L' .o" ~ a", Minnesota Lawful Gambling ~?"?waty LG215 Lease for Lawful Garrtbling Activity ,r,D Page 1 oft heck applipble Item: 1. New application. Submit lease will[ new premises permit application, 2. Naw owner. Effective date SuhmB new lease within 10 days after new lessor assumes ownership. ?3. New lease. (Do not submit existing lease with amended changes). y,,,. ~ _~a Date that changes will be eHedive. Submit changes al least 10 days hefore the effective date of the change. Organization name Address ~N~A License number Daytime phone Gl7Tl E L~R/I/.~7-D~ ~'A~Yr4DGrR,U ,d s crrrrE e~,?rr~oR m,~, ~`~x ~ ~~~na N~a]mhhe o~nfl leased premises Street address Ciry State Zip Daytme phone rC/Rf70 v7sao /Z~P~ ai,~T ufil~'CA~URDA MN S5//-~ ($~~r eme ~f legal owner of premises Business/street adtlress City State Zp DayUme phone Name of lessor (If same as legal Business(street atldress City Slate Zip paytime phone owner, write in "SAME") SxJm~ Chedi alC;adivit3esi hat wtft-b'e condu2teii _ , : Pull-tabs IlPUII-tabs with dispensing device rpboards,aPaddlewheel OPaddlewheel with table nBingp ~ 6ar 61ngo . , Pull:, tab, ?ipbperd, and P~tldlewheel Rent (No Lase i•eiiulred fprratfles r' Booth operation -sales of gambling equipment by an employee Bar operation -sales of gambling equipment wtthln a leased (or volunteer) of a licensed organization within a separate endosure premises by an employee of the lessor hom a common area where that Is disdntt from areas where food and beverages are sold. food and beverages are also sold. ~Dces ~;y uo ~o aNOn ORanv other omanizaHon conddct aambbna from a booth oporahon at this location?.: Yes ~No p. L ~a ........J if you answered~fe5 to the question above, rent limits are If you answered rl0 to the question above, rent limits are based on the following combinations of operation: based on the following mmbinations of operation: - Booth operation Bar operation - Booth operation and pull-tab dispensing device - Bar operation with pull-tab dispensing device - Booth opeation~and bar operation - Puil-tab dispensing device only • 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: COMPLETE ONE OPTION: Option A: D to 10% of the gross profits per month. Percentage Option A: D to 20% of the gross profits per to ba paid % month, Percentage to be paid Option B: When gross profits are $A,D00 or less per month, $D Option 6: When gross profits are $1,OOD or less per month, $0 to $a00 per month may be paid, Amount to be paid $ to $200 per month maybe paid. Amount to be paid $ Option C; $0 to $400 per month on the first $4,000 of gross Opton C: $0 to $200 per month on the first $1,000 of gross profit, Amount to be paid $ profits. Amount to be paid $ Plus, 0%to 10% of the gross profits may be paid per month on Plus, 0% to 20% of the gross profits may be paid per month on gross profits over $M1,000. Percentage to be paid % gross profits over $1,000. Percentage to be paid % Bingo:Rept ~ :°BaY BTn o;Rent , Option D: D to 10% of the gross profits per month hom all _ Option P: No rent maybe paid for bingo lawful gambling activities held during bingo occasions, exduding conducted in a bar. bar bingo. Percentage to be paid % Option E: A rate based on a cost per square foot, not to exceed ]30% of a comparable Lost per square foot for leased space, as New ~lTagO /AC~.IVit~l ` ~ approved by the director of the Gambling Cgntrol'BOaid. No rent may For any new bingo activity no[ previously be paid for baf bingo. Rate to be paid $ per square foot, inducted in a Premises Permit ApplipHon, attach cenfinn the comparable ate and all applicable costs to be.paid by the a separate sheet of paper listing the days and organization to the lessor. The lessor must attach documentation, hours that bingo will be tbnduded. verified by the organization, to