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Minnesota Lawful Gambling <br />Lease for Annual Off -Site Gambling Activity - LG224 <br />Name of Legal Owner of Property ,% Street Address y/- (� jCity / /J State /Zip Ain, Phone <br />% <br />C / l 4' f L; ij /fa' C ncid4 i .-c4, S, Us l 14 eacatl4 !' in, J -7 6.5 7�y�' <br />Nam of Lessor Street Address City State Zip Daytime Phone <br />(If s m /ee as legal owner, write in "SAME ") <br />Name of Leased Premises Street Address. or road <br />r� • r 4-.4- Wig t-2, .L . f <br />ame of Lessee (name of organization leasing the premises) <br />lo, 4/4,C441Ci 0- /7- !✓ncti rp, S <br />designations City Zip Daytime Phone <br />., , , y 4 j ` e <br />Organization license number Daytime Phonic <br />ai'i✓2 /9 lr:i /-4 de.-›FIV <br />Activity <br />Beginning <br />Date(s) <br />date of off -site activity: g /,.2- 1Q2- .. Ending date of off -site activity: e' / / U2✓ <br />Type of <br />Check <br />Gambling Activity <br />the box(es) which indicate(s) the type of gambling activity that will be conducted for this one -day off-site activity. <br />Bingo Raffles Paddlewheels I j Pull -Tabs ✓I Tipboards <br />Rent <br />Rent to <br />Information <br />be paid for the leased area: <br />• Rent may not be based on a percentage of receipts, <br />profits from lawful gambling, or the number of <br />participants attending a bingo occasion, <br />• An organization may not pay rent to itself or to any of <br />its affiliates for space used for the conduct of lawful <br />gambling. <br />$ — o •_-_ <br />(If none, write -0 -) <br />OTHER OBLIGATIONS AND AGREEMENTS - Attachment <br />All obligations and agreements between the organization and the lessor are listed below or attached to this lease. <br />(Attach additional sheets if necessary. Any attachments to this lease must be dated and signed by both the lessor <br />and lessee,) <br />This lease is the total and only agreement between the lessor and the organization conducting lawful gambling <br />activities. There is no other agreement and no other consideration required between the parties as to the lawful <br />gambling and other matters related to this lease. <br />i <br />// <br />.//1 >'1 g,_,' /- /‘•-'62- <br />Signature of Lessor Date ,Signature of Organization Official (Lessee) Date <br />`ir frrr A:' /u�t'�Oli &.9i'l'rfi! 1 d .�=:c <br />, <br />Print Name of Lessor Print Name and Title of Person Signing on Behalf of <br />Organization <br />Questions on this form should be directed to your licensing <br />specialist at the Gambling Control Board at 651- 639 -4000. <br />Hearing impaired individuals using a TTY may call the <br />Minnesota Relay Service at 1- 800 - 627 -3529 and ask to place <br />a call to 651- 639 -4000. <br />This publication will be made available in alternative format <br />(1.e. large print, Braille) upon request. <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 cornpliance with Minnesota statutes and rules <br />governing lawful gambling activities. <br />4/00 <br />