05-23-2007 Council Agenda - Laserfiche WebLink

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Minnesota Lawful Gambling LG215 Lease for Lawful Gambling A 5/06 Page 1 of 2 Check applicabie item: 1. Lease for new application. r. 2. Renewed lease. Submit with Submit with new premises permit premises permit renewal. amended lease within 10 days after in the lease: Rent Premises application. new lessor assumes ownership. name Booth/bar Date effective Activity change / / 3. New owner. Submit new or _ 4. Amended lease Other _ • Check the change(s) Date that chances will • Both parties must initial • Submit chances at least be effective / / and date all changes. 10 days prior to the chance. Organization name License number i i / �. _ Daytime phone Name of leased premises !'i '. 1 ' i �I °� �/i i i c (._.' lL 'r.J ' ' T /71— Street address City re/ /l//LP p�( 'f! ' //LP Ni; ,9rlrOii' State NIN Zip v J� // Daytime phone W V ? 7rJ�� J�' /�- Name of legal owner of premises Business /street address ! City c1CL % In„ y State Zip \j--5—I/ 7 Daytime phone sig Name of lessor Of same as legal owner, write in "SAME ") Sri c Business /street address ; City . State Zip Daytime phone Check all activities that will be conducted: .Lot Pull -tabs Pull-tabs with dispensing device Tipboards . ' Paddlewheel _Paddlewheel with table _Bingo bingo _Bar Pull -tab, Tipboard, and Paddlewheel Booth operation - sales of gambling equipment by an employee (or volunteer) of a licensed organization within a separate enclosure that is distinct from areas where food and beverages are sold. r Does your organization OR any o L from a booth operation at this If you answered yes to the question above, rent limits are based on the following combinations of operation: - Booth operation - - Booth operation and pull -tab dispensing device - Booth operation and bar operation - 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: Option A: 0 to 10% of the gross profits per month. Percentage to be paid % Bar premises food her organization location? If you based - Bar - Bar - Pull The per Complete Option Percentage Option to $200 Option of gross 20% over Rent (No lease required operation - sales of gambling by an employee of the lessor and beverages are also sold. conduct_ gambling Yes X No for raffles.) equipment from a common above, rent of operation: device not exceed at this premises. profits per month. % $1,000 or less to be may be paid $ within a leased area where J limits are $2,500 in total per month, $0 paid $ answered no to the question on the following combinations operation operation with pull -tab dispensing -tab dispensing device only maximum rent allowed may month for all organizations one option: A: 0 to 20 %ofthe,.gross to be paid 0 Option S: When gross profits are $400 per month may be paid. Amount Option C: $0 to $400 per month of gross profit. Amount to be paid 10% of the gross profits may be over $4,000. Percentage to be paid $4,000 or less per month, $0 to to be paid $ . 13: When gross profits are per month may be paid. Amount C: $0 to $200 per month profits. Amount to be paid of the gross profits may be paid $1,000. Percentage to be paid may be paid on the first $4,000 $ . Plus 0 %to on the.first $1,000 . Plus 0% to paid per month on gross profits % per month on gross profits % Bingo Option D: 0 to 10% of the gross gambling activities held during bingo Percentage to be paid Rent profits per month from all lawful occasions, excluding bar bingo. % per square foot not to exceed 110% foot for leased space, as approved Board. No rent may be paid for per square foot. by bar to Bar Option F: Bingo Rent No rent may be paid for bingo conducted in a bar Option E: A rate based on a cost of a comparable cost per square the director of the Gambling Control bingo. Rate to be paid $ New Bingo Activity For any new bingo activity not previously included in a Premises PermitApplication, attach a separate sheet of paper listing the days and hours that bingo will be conducted. The lessor must attach documentation, verified by the organization, confirm the comparable rate and all applicable costs to be paid by the organization to the lessor. 7