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Minnesota Lawful Gambling <br />LG224 Lease for Off -Site Gambling Activity <br />6/07 <br />Name of legal owner of property Street address City State Zip Daytimephone ,SSfi i <br />errtt o r Inta e41-4M-OP_,_J5 urr e nrnvAIiA- 2£AAO (-IMF e4-41141-DA- O. <br />1 <br />Name of lessor (if same as legal Street address City Styate Zip Daytime phone <br />owner, write in "SAME") 6 S I -7.7(0 ,- zioa9 <br />Name of leased premises Street address, or road designations City Zip Daytime phone <br />S POD A)PE Pal2K 351 ELI l7 oo0 Ll#ww CA�vA -i2 J, 55111 <br />4 <br />Name of lessee (organization) ) Organization license number} Daytim on <br />5 515 LITZE 0A1011- 1D,4'p2oAD` LI rTUr CANADA, <br />ti rrtE °A414O iQ -Qt l 7 ,, <br />Gambling Activity , .57/7 <br />1. Beginning date of off-site activity ,4ij& -ti ST / Ending date of off -site activity i•1-Lf(+21,ST 5 200 g <br />2. Check ('1) the type of gambling activity that will be conducted for this off -site activity. <br />,% pull -tabs bingo T._ tipboards __ paddlewheels (No lease is required for raffles) <br />Lease Obligations <br />1. Rent to be paid for the leased area $ 0 If none, write "0" <br />2, All obligations and agreements between the organization and the lessor are listed below or attached to this lease. <br />Any attachments to this lease must be dated and signed by both the lessor and lessee. This lease (and any <br />attachments) is the total and only agreement between the lessor and the organization conducting lawful <br />gambling activities. <br />Other terms <br />N. <br />(�? Z/ V <br />„c_ /c 98 iLev/ 91 <br />Sign ure of lessor Dat ' •/ ture of organ i ation official (lessee) Date <br />i <br />J0CL. ciLIAAJ Soti kerYOloill A uao/0 <br />Print name Qf lessor Print name and title of person signing on behalf of <br />C rry A-0 M )4)15-02A--1-012_ organization 0E0.0 -0i DDS <br />This publication will be made available in alternative format (i.e. large print, Braille) upon request. <br />The information requested on this form will become public information when received by the Board, and will he used <br />to determine your compliance with Minnesota statutes and rules governing lawful gambling activities. <br />3 <br />