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Minnesota Lawful Gambling <br />LG224 Lease for Off -Site Gambling Activity <br />5/04 <br />Name <br />/ <br />of legal owner of property Street address City State Zip Daytime phone number <br />" t <br />&[Lii7Ze--; 40ig 57S�177Z /�f9 -i4-/ ur /c6 f / 119/(1 <br />Name of lessor Street address City State >Zip Daytime phone number <br />(If same as legal owner, write in "SAME ") 65' /_ 766 —SI(f? <br />Name of leased premises Street address, or road designations City Zip Daytime phone number <br />5/t oA/EJe ftraC7 0 T CO 12of -D/ Llirz& V A-D4/ MAk 651 -71� -9 a? <br />Name of lessee (name of organizatiorfleasing the premises) Ofganization license number Daytime phone number <br />Gam»- r) /61/0-J/4ts, Aid? % -DViy 6s1- 766 --910 al <br />Gambling <br />1. Beginning <br />2. Check <br />3. Rent <br />4. All <br />Any <br />Activity and Lease • b - gations <br />date of off -site activity I. 0 Ending date of off-site activity 8 6 06 <br />the type of gambling activity that will be conducted for this off -site activity. <br />Vull -tabs bingo (No lease is required for raffles) <br />_tipboards _paddlewheels <br />to be paid for the leased area $ V If none, write "0." <br />obligations and agreements between the organization and the lessor are listed below or attached to this lease. <br />attachments to this lease must be dated and signed by both the lessor and lessee. <br />This <br />gambling <br />as <br />lease is the total and only agreement between the lessor and e‘organization conducting lawful <br />activities. There is no other agreement and no other c sidd ation re uir d e en the parties <br />to the lawful gambling and other matters related to this leas { y� /erg/ 11--4 / <br />Sig <br />ei ry <br />tureofle sor D to Si nature of or anizationoffci�y(les ee. ( Date <br />try H��ni�is�d i�, <br />�rhyso�tl/ N� rzl <br />of e- rt ft'91— FJ4m /- /n/GMA1/24 -te/L <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 />6 <br />