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Minnesota Lawful Gambling <br />LG230 Application to Conduct Off -Site Gambling <br />Print Form <br />Page 1 of 2 1/10 <br />No Fee <br />Organization name Little Canada Canadian Days, Inc. <br />License number 80421 <br />Address 515 Little Canada Road city Little Canada MN Zip code 55117 <br />Gambling manager name Dotty D. Norgard Daytime phone <br />Gambling Activity <br />651-766-4034 <br />1. Four off -site events are allowed each calendar year. Dates for each event, not to exceed 3 days. <br />July 29 -31, 2011 <br />2. Check the gambling activity that will be conducted. <br />❑ raffle <br />_.pull -tabs ,bingo 0 tipboards lipaddlewheel <br />Gambling Premises <br />3. Name of location where gambling activity will be conducted Spooner Park Pavalion <br />4. Street address and city Eli Road, Little Canada, MN. 55117 <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 />5. 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 />Lease Agreement for Off -site Activity (A lease agreement is not required for raffles.) <br />6. Rent to be paid for the leased area $ 0 If none, write "0." <br />7. 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 <br />organization conducting lawful gambling activities. <br />. Other terms, if any <br />8. Lessor's signature <br />Print lessor's name <br />Joel Hanson, City Administrator <br />L. <br />Date <br />CON'I'INt11i 'r0 PA(ili 2 <br />2 <br />