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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 />Little Canada Canadian Days, Inc. 04219 <br />Organization name License number <br />515 Little Canada Road Ci• Little Canada 5511 <br />Address ty MN Zip code <br />Dotty Norgard 651-587-6864 <br />Gambling manager name Daytime phone <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 />August 3, 2012 August 4, 2012 August 5, 2012 <br />2. eck the gamblirictivity that will <br />raffle pull-tabs <br />onducted. <br />bingo .r- i tipboards Fl paddlewheel <br />Gambling Premises <br />3. Name of location where gambling activity <br />4. County [where gambling activity will be <br />5. Street address and city Bi Road, Little <br />will be conducted Spooner Park <br />conducted Ramsey <br />Canada, MN. <br />0 Do not use a post office box. <br />O If no street address, write in road designations. Example: 3 miles east of Hwy 63 on <br />County Road 42. <br />6. t es your organization own the gambling premises? <br />Yes If yes, a lease is not required. <br />F1 No If no, the lease agreement below must be completed, and signed by the lessor. <br />.. <br />Lease Agreement for Off-site Activity <br />7. Rent to be paid for the leased area $ <br />G. All obligations and agreements between <br />attached. <br />_ Any attachments must be dated <br />— This lease and any attachments is <br />the organization conducting lawful <br />Other terms, if any <br />A lease agreement is not required for raffles. <br />0.00 _ If none, write "0." <br />the organization and the lessor are listed below or <br />and signed by both the lessor and lessee. <br />the total and only agreement between the lessor and <br />gambling activities. <br />9. Lessor's signature Date <br />Print lessor's name City of Little Canada <br />CONTINUE TO PAGE 2 <br />