05-25-2005 Council Agenda - Laserfiche WebLink

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Minnesota Lawful Gambling 11/04 LG215 Lease tor Lawtul Gambling Activity Page 1 of 2 Name of legal owner of premises Business /street address City State Zip Daytime phone GG;QIe.`J , Inc, 020/ C. L,I //r C-- i) =.c% RD. LC, (H • CC 117 65I- Y Name of lessor Business /street address City State Zip Daytime phone Of same as legal owner, write in "SAME") S'c.m0 Name of leased premises Street address City Zip Daytime phone Gocd'ie.S pleLCQ ,701 E. L i (-+Lrz. ( cSc. R). LC. ink). 5-511 7 GS'1- y6y- Name of lessee (organization leasing the premises) Organization license number Daytime phone L-/He Cvlo c, VOL F;fe- -Pci4 1- /1'006V-Oog 651-766- (76 Rent Information (for activity involving pull -tabs, tipboards, paddlewheels, and 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. f- Does your organization OR any other from a booth operation at this L 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 the limits established under Minnesota Statute 349.18, Subd. 1(b)(4). The limit as of May 1, 2004 is $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 % pull -tab dispensing devices. No lease required for raffles.) Bar operation - sales of gambling equipment within a leased premises by an employee of the lessor from a common area where food and beverages are also sold. organization conduct mining location? Yes No _ -1 If you answered no to the question above, rent limits are based on the following combinations of operation: - Bar operation - Bar operation with pull -tab dispensing device - Pull -tab dispensing device only The maximum rent allowed may not exceed the limits established under Minnesota Statute 349.18, Subd. 1(b)(4). The limit as of May 1, 2004 is $2,500 in total per month for all organizations at this premises. Complete one option: Option A: 0 to 20% of the 4 ss profits per month. Percentage to bepaid <RC" % Option B: When gross profits are $4,000 or less per month, $0 to $400 per month may be paid. Amount to be paid $ Option B: When gross profits are $1,000 or less per month, $0 to $200 per month may be paid. Amount to be paid $ . Option C: $0 to $400 per month may be paid on the first $4,000 of gross profit. Amount to be paid $ . Plus 0% to Option C: $0 to $200 per month may be paid on the first $1,000 of gross profits. Amount to be paid $ . Plus 0% to 100/0 of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid % 20% of the gross profits may be paid per month on gross profits over $1,000. Percentage to be paid Chefleall activities that will be conducted: Pull -tabs _Pull-tabs with dispensing device Tipboard Paddlewheel Paddlewheel with table Rent Information: Bingo and /or Bar Bingo Occasions Rent for bingo and all other gambling activities conducted during a bingo occasion may not exceed: • $200 per occasion for up to 6,000 square feet • $300 per occasion for up to 12,000 square feet • $400 per occasion for more than 12,000 square feet • $25 per occasion for bar bingo conducted at any time in bar (regardless of square footage). Your organization must conduct another form of lawful gambling, and the premises must serve intoxicating liquor or 3.2 percent malt beverages. Rent to be paid per bingo occasion $ Bingo Noon Hour Bingo Occasions Rent may not exceed $25 per day for noon hour bingo conducted between 11 a.m. and 2 p.m. at a premises with a license for the sale of intoxicating beverages on the premises. a Rent to be paid per bingo occasion $ r For any new bingo activity not previously I included in a Premises Permit Application, I I attach a separate sheet of paper listing the L days and hours that bingo will be conducted. ' Amended If this is an amended lease showing changes occurring that signed the lease must initial and date all changes. Lease at least 10 days prior to the change. Write in the Only Lessor Date Organization during the term of the current premises permit, both parties Changes must be submitted to the Gambling Control Board date that the changes will be effective / / Date 7- Fi/ - L 9.z <7692 S7