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Minnesota Lawful Gambling <br />LG230 Application to Conduct Off -Site Gambling <br />Page 1 of 2 5/11 <br />No Fee <br />Organization name L-144/c, 6 Ode., kcc,rti 16//,,;''4is/t�u License number 3'157b <br />Address ffi mAdz >� City L' HLf & ,aL MN Zip <br />code <br />-CS-0 <br />Gambling manager name <br />y <br />rave 61 L',n,^r-{k Daytime phone CS(' 71C <br />• /93 <br />Gambling Activity <br />1. Four off -site events are allowed each calendar year. Dates for each event, not to exceed <br />3 days. <br />Rc)D L( <br />2. eck the gamblil�e <br />ctivity that will <br />pull -tabs <br />onducted. <br />I tipboards J <br />(� <br />l paddlewheel <br />raffle 11. <br />� j <br />bingo I T <br />Gambling Premises <br />3. Name of location where <br />4. County [where gambling <br />5. Street address and city <br />• Do not use a post <br />• If no street address, <br />County Road 42. <br />6. Ayes your organization <br />gambling activity <br />activity will be conducted <br />L t \4tc Can <br />will be conducted <br />! avnstLI <br />Ge✓uiw.y ( ee- <br />�,.,, MN I Ed -4w, + ,-H-Ie ah t,c i <br />/ <br />office box. <br />write in road designations. Example: 3 miles east of Hwy 63 on <br />own the gambling premises? <br />is not required. <br />lease agreement below must be completed, and signed by the lessor. <br />fYes If yes, a lease <br />FillNo If no, the <br />Lease Agreement for Off -site Activity A lease agreement is not required for raffles. <br />7. Rent to be paid for the <br />8. All obligations and agreements <br />attached. <br />_ Any attachments <br />_ This lease and any <br />the organization <br />_ Other terms, if any <br />leased area $ 0 If none, <br />write "0." <br />the lessor are listed below or <br />lessor and lessee. <br />between the lessor and <br />between the organization and <br />must be dated and signed by both the <br />attachments is the total and only agreement <br />conducting lawful gambling activities. <br />9. Lessor's signature Date <br />Print lessor's name <br />CONTINUE TO PAGE 2 <br />d <br />