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Minnesota Lawful Gambling <br />LG224 Lease for Off -Site Gambling Activit <br />5/04 <br />Name of legal owner of property Street address City State Zip Daytime phone number <br />girl/ a' WILE i9r/1//5.DN7 &s 7/772E &A�/,9.J »M, �rTx� c7, /, 4 <br />Name f lessor Street address City State Zip Daytime phone number <br />Of same as legal owner. write in "SA /ME ") 451 — <br />rx�INI�,C /ri:e4 , 5s G/ a/ 49--CI , Lii/Gb 14 -7W,4 i'w 357/7- 7�i-t/ <br />Name of leased premises S reet address, or road designations City , Zip Daytime phone number <br />/mM112 9/914 riie , ,,6d)5/07 19 657-766 - /{G13y' <br />Name of lessee (name of organization leasing the premises) Organization license number Daytime phone number <br />Gambling Activity and Lease Obligations y <br />1. Beginning date of off -site activity Atte- 2i zoo 7 Ending date of off -site activity l LLE J) ao97 <br />2. Check the type of gambling activity that will be conducted for this off -site activity. <br />IVpull-tabs lease is <br />_bingo _tipboards _paddlewheels (No required for raffles) <br />3. Rent to be paid for the leased area $ 0 If none, write "0." <br />4. 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. <br />This lease is the total and only agreement between the lessor and the organization conducting lawful <br />gambling activities. There is no other agreement and no other.. deration r- quired between t e parties <br />as tthh lawful rnblbliling and �other matters relaedto this lea .- <br />-i <br />ature o e sor / \, a i naturfor aniz.fon official (lessee) pate <br />a�yp (' 'r.'fyZ -) - f� G�LSi� / % nt-e .i�6J26/�sr 4 enin/JG//U� <br />g/Y cA"U77Zraci -th 74. O /17 71✓ c,.,�'? <br />Print name of lessor Print name and title of person signing on behalf of <br />organization <br />This publication will be made available in alternative format <br />(i.e. large print, Braille) upon request. Questions on this <br />form should be directed to your licensing specialist at the <br />Gambling Control Board at 651- 639 -4000. If you use a <br />TTY, you can call the Board by using the Minnesota Relay <br />Service and ask to place a call to 651- 639 -4000. <br />The information requested on this form will become public <br />information when received by the Board, and will be used to <br />determine your compliance with Minnesota statutes and rules <br />governing lawful gambling activities. <br />-3 <br />