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Sent By: AMF SO REGION; <br />Minnesota Lawful Gambling <br />Lease for Pull -Tab, Paddlewheel, Tipbaard, and/or Raffle Activi`..: -L0221 <br />Name of usual Owner of Premises Street Address City Tip Deydme Phone <br />AMP BOWLING 8100 AMP DR MECRANICSVILLE, VA 23111 ( 1 800 342 5261 <br />7704251637; <br />9 Jan'02 4:11PM; Job 301;Page 1 <br />Name of Lessor Street Address <br />wow legal owner, write is "SAME") <br />City 9p Daytime Phone <br />Nameofl.easedPmmes StmetAdsees City Zip DaytimePhane <br />SAYCON BOWLING LANSS 61 W LITTLE CANADA RD LITTLE CANADA, Iii 55117 <br />Name of Lessee (nn of organisation leasing the premises) GCB license no. of organization Dayt ine Phone <br />LITTLE CANADA CANADIAN DAYS B04219 651 484 5904 <br />Rent Information <br />• Total rent cannot exceed 11,000 per month for all <br />non -bingo activity for this premises. <br />• For bingo activity, use lease tom .Lta.,.. <br />• For pull -tab dispensing machines, use tease form <br />LG223: <br />• An organization may not pay rent to itself or to <br />any of its affiliates for space used for the conduct <br />of lawful gambling. <br />Rent to paid per month APRIL ONLY <br />300.00 <br />(lino roM a lobo paid, indicate -0.) <br />Sketch and Dimensions of Leased Area <br />Sketch: For all areas being leased for the conduct <br />of gambling and storage of gambling product at this <br />premises, attach a sketch (drawing) showing: (1) the <br />leased area(s), and (2) the dimensions. <br />Dlmenalona — <br />The leased areas are 12 feet by 5 <br />feet by <br />feet byy <br />Storage feet by <br />Storage feat by <br />feet fora total of 60 square feat. <br />feet fcr a total of st(uere feet. <br />feet for a total of- square feet. <br />feet for a total of square feet. <br />feet fora total of square feet. <br />Combined total 60 square feet. <br />Lawful Gambling Activity <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br />Paddlewheels x Pun -Tabs <br />___Raffles Tipboards <br />Term of Lease <br />Amended Lease Only <br />The tarenof this lease agreement twhtba concexsenteaterthw <br />premises permit issued by the Gemblhng Control Board, <br />unless terminated sooner by annual ism of the lessor <br />andlessee. <br />If this lean an tease showing changes occurring dur- <br />ing the term of the current premises permit, write an the <br />data that the changes will he effective / . <br />Both patties that signed the lease must initial and date se <br />changes. <br />Questions on this fern should be directed to the !loanable <br />air. io r of the Gambling Control Board et (612) 6394000. <br />This publication will be made available In ettemattve format <br />0.as. large print, Braille) upon requeet. Hearing impaired <br />irecaads using a TTY may seethe Minnesota Relay Semite <br />at 1.800- 627 -3529 and ask to place a call to (612) 6394000. <br />1•d <br />1.6174 -t'B.0- 159 <br />The information requested on this form will be used by the <br />Gambling Control Board (Board) to determine your compliance <br />with Minnesota statutes and rules governing lawful gambling <br />activities. AU of the information that you supply on this form <br />will become pubtto information when received by the Board <br />except, if required, your Soaal Security number. which remains <br />private. <br />uasueH uouee <br />Page 1of2 <br />Rev. 6/97 <br />doa :so Z0 ED ue' <br />sip x .+m ahea,. ar.�ral:r <br />