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Minnesota Lawful Gambling <br />Lease for Pull -Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 <br />City Zip Daytime Phone <br />Name of Legal Owner of Premises Street Address <br />.1.61 ruts V1.4703° . 34 gp Vak/if °Cr <br />Name of Lessor Street Address <br />Of same as legal owner, write in "SAME) <br />Vene-I-;an `Inn , Thc-. <br />Name of Leased Premises Street Address <br />Venetlarl tnn, Z✓Ic. 2814 616.e S <br />Name of Lessee (name of organization leasing the premises) <br />L N le Canada 0_,AnadlaviJkZ.ys t rx-. <br />Rent Information <br />.2814 1Zi� <br />SE. Paul 55I2-/ <br />City Zip Daytime Phone <br />(1°51 )42q-7„m5 <br />5+ LfFIC afttda 55113 ( (51 ) 48971.15 <br />City Zip Daytime Phone, <br />}- LAC— Canada. 55/13 ((51 )1434- —7.2.1 <br />GCB license no. of organization <br />B- h4.21r1 <br />Daytime Phone <br />( (p 5/ )484/- 5oi09 <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 />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: <br />Storage <br />Storage <br />7 feet by 9 <br />Lawful Gambling Activity <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br />feet by <br />feet by <br />feet by <br />feet by <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 $ , 000 .0 <br />(If no rent is to be paid, indicate -0-) <br />For Premises Permit Renewal Applications nly., If no <br />changes "have been made at* o <br />**Site, you do not have to <br />comptetethis section orprovide a sketch <br />• <br />feet for a total of �0 3 square feet. <br />feet fora total of <br />feet for a total of <br />feet fora total of <br />feet for a total of <br />Combined total <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />(3 square feet. <br />Paddlewheels Pull -Tabs <br />Term of Lease <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 />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 />_Raffles <br />Amended Lease Only <br />Tipboards <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 />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 12 <br />Page 1 of 2 <br />1/99 <br />