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Minnesota Lawful Gambling <br />Lease for Pull -Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 <br />Name of Legal Owner of Premises Street Address City State <br />AMF BOWLING 8100 AMF DR. MECHANICSVILT,E VA <br />Zip Daytime Phone <br />23J11 200 347 576 <br />Name of Lessor Street Address City State <br />(If same as legal owner, write in "SAME ") <br />SAME <br />Zip Daytime Phone <br />Name of Leased Premises Street Address City Zip <br />(C�AAnl� A r <br />Daytime Phone <br />-52u355 <br />SaYn' BOWLING LAVES C1 W LITTLI1� <br />Name of Lessee (name of organization easing the premises) 'GCt3nCe s�r�. of di'gTa�ii ii <br />LITTLE CANADA CANADIAN DAYS 804219 651 484 <br />`800342 <br />fyya�iiif -� Phdli� 1 I/ <br />5904 <br />Rent Information <br />Total rent cannot exceed $1,000 per month for all <br />non -bingo activity for this premises. <br />For bingo activity, use lease form LG222. <br />For pull -tab dispensing machines, use lease 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 be paid per month $ 300.00 <br />(If no rent is to be 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 />Dimensions <br />The leased areas are: 1 2 <br />Storage <br />Storage <br />feet by F <br />feet by <br />feet by <br />feet by <br />feet by <br />For Premises Permit Renewal Applications Only: If no <br />changes have been made at the site, you do not have to <br />complete this section or provide a sketch. <br />feet for a total of 60 square feet. <br />feet for a total of square feet. <br />feet for a total of square feet. <br />feet for a total of square feet. <br />feet for a 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 <br />I e <br />Pull -Tabs <br />Raffles <br />Tipboards <br />Term of Lease <br />Amended Lease Only <br />The term of this lease agreement will be concurrent with <br />the premises permit issued by the Gambling Control <br />Board, unless terminated sooner by mutual consent of <br />the lessor and lessee. <br />If this is an amended lease showing changes occur- <br />ring during the term of the current premises permit, <br />write in the date that the changes will be effective <br />Both parties that signed the lease <br />must initial and date all changes. <br />Questions on this form should be directed to the Licensing <br />Section of the Gambling Control Board (Board) at 651 -639- <br />4000. This publication will be made available in alternative <br />format (i.e. large print. Braille) upon request. Hearing Impaired <br />individuals using a TTY may call the Minnesota Relay Service <br />at 1- 800 - 627 -3529 and ask to place a call to 651- 639 -4000. <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 compliance with Minnesota statutes and rules <br />governing lawful gambling activities. <br />Page 35 <br />Page 1 of 2 <br />1/99 <br />