01-14-2004 Council Agenda - Laserfiche WebLink

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Minnesota Lawful Gambling LG215 Lease for Lawful Gambling Activity Name of legal owner of premises Street address / Name of lessor e Street address (If same as legal. owner, write in 'SAME") Jj Name of teased premises City 8/03 Page l of 2 -. State • _ Zip Daytime phone Tp Daytime phone State Street address . City . -r ?L's Name of lessee (organization leasing the preniises) Zp Daytime phone .':7 Organizationlicensenumber D.aytime.phone / Rent information . (for activity involving 'pull-tabs, tipboards,.paddlewheels, and pull -tab dispensing device. No !ease required for taffies.) Booth operation - sales of gambling equipment by an employee (or - Bar operation -sales of gambling equipment within a leased . volunteer) of a fiord organisation within aseparate enclosure that is premises by an employee of lessor from a common area where distinct from areas where food and beverages are sold. food and beverages are also sold. . Does your "organization OR any other organization conduct' ambling from a booth operation at this location? Yes . - ./( No r If you answered ye$ to the question above; rent limits are based On the following combinations of Operation: Booth operation • - Booth operation and pall -tab dispensing device - Booth operation and bar operation - Boofhoperation ; bar operation, and pult -tab dispensing device The rnaidmurn rent-allowed may not $1,750 in total per month for all organizations at this premises. Complete one option:. - - Option A: O to 10% Of the gross profits per month. Percetttagetobepaid- '• OptionI: When gross prefab are $4,000or less permonth, $Rto $400 per' month may be paid: Amount to be paid $ • • . . Option L: $0 to $400 per month may bepaid on the first $4,000 of-gross prefit.:Ainounttobepaid $ • Plus 0 %to 10% (tithe gips. profits may be paid per month on gross profits over$4,000: Percentage loo be paid . % • . If you answered fO-tb 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 tent allowed may not exceed $2,0601h total per month for all organ nations at this premises. Complete one option: .. Option A: 0 to 20% of theRrossprofits tiernionth. ' PercentagetobePaid ",.D: •% .. Option 3: When anis5.p -efits are $1,006 or less pet rrpnth, $0 to $200 per month may be.paid: •Ainount to be paid $ . • Option C: • $0 to $200 pernionth maybe paid on the first $1,000 ofgross profits. .Amount tobepaid.$ . PlusO %to 20% of the grog; profits maybe paid permonth on gross profs is • over$1,000. Peiicentage to bepaid . %' NOTE: :If there areaniotber terms or conditions for rent-related all activities that Will beconduded: . expenses, they mustbe idenfifiedonpage 2 underActn"iowiedgment VPQIRabs _Pull-tabs with dispensing device of Lease Terms and are subject to Board approval. - . . I Tipboards. _ Paddlewheel- _ Paddlewheel with table • Rent Information: Bingo Bingo a bd /or Bar Bingo Qocasions Noon Hour Bingo Occasions Ingo 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 a bar (regardless of square footage). Your organization must conduct- another form of lawful gambling, and the r -I premises must serve intoxicating liquor or 32 percent Foram/ new bingo activity not previously - matt beverages, f inciudedina Premises permitapplication, • 1 attach a separate sheet of paper listing the Rent to be paid per bingo occasion $ L clays and hours that bingo be conducted. 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. Rent to be paid per bingo occasion $ Amended If this is an amended lease showing changes occurring during the tenn of the current premises permit, both parties Lease that signed the lease must initial and date ail changes. Changes must be submitted to the Gambling Control Board at least 10 days prior to the change. Write in the date that the changes will be effective / / Only Lessor Date Organization Date 2