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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 <br />AMF BOWLING 8100 AMF DR. <br />City State Zip Daytime Phone <br />MECHANICSVILLE VA ?111 Ron 'i42 57ti° <br />Name of Lessor Street Address <br />(If same as legal owner, write in "SAME") <br />SAME <br />City State Zip Daytime Phone <br />Name of Leased. Premises Street Address <br />City Zip DaytimePhone <br />800342'52.3 <br />C <br />' <br />_ • I e•.� <br />Name of Lessee (name of organization easing the premises) <br />LITTLE CANADA CANADIAN DAYS <br />- r i r qer• rq <br />C= ]- • - . of • • • i i s . ' Ph -' <br />804219 651 484 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 feet by <br />feet by <br />feet by <br />Storage feet by <br />Storage 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 fora total of <br />feet fora total of <br />feet for a total of <br />feet for a total of <br />feet for a total of <br />Combined total 6 0 <br />50 <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />Lawful Gambling Activity <br />Type of gambling activity thatwill be conducted at this gambling premises. Check all that apply. <br />Paddlewheels <br />Pull -Tabs <br />nRaffles 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, untess 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 altemative <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 />goveming lawful gambling activities. <br />Page 1 of 2 <br />1199 <br />