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MINNESOTA LAWFUL GAMBLING <br />L6230 Application to Conduct Off -site Gambling <br />12/12 Page 1 of 2 <br />No Fee <br />Organization Information <br />Organization <br />Address <br />county <br />name Little Canada Recreation Assn. License number 34510 <br />515 Little Canada Rd cyw Little Canada MN Zip code 55117 <br />Ramsey <br />Gambling <br />manager name Katie McGinnity Daytime phone (651) 775 -5993 <br />Gambling Activity <br />1. Four off -site events are allowed each calendar year. Dates for each event, not to exceed 3 days. <br />ina,(� I v x/201 )) 3 <br />2. Check the gambling activity that will be conducted, <br />X raffle X pull -tabs bingo tipboards paddlewheel <br />Gambling Premises <br />3. Name <br />4. County <br />5. Street <br />• <br />• <br />6. <br />of location where gambling activity will be conducted pi Q'v. 2. c.r Pa! k <br />[where gambling activity will be conducted Ramsey <br />rr <br />address and city [or township] iI'?S D r2,4croi( ie. iZ -r( ).,,,14k<. Ct„vt,,.ar. -Zip code S ''` I 17 <br />Do not use a post office box. <br />If no street address, write in road designations. Example: 3 miles east of Hwy 63 on County Road 42. <br />your organization own the gambling premises? <br />s ? <br />Yes If yes, a lease is not required. <br />No If no, the lease agreement below must be completed, and signed by the lessor. <br />Lease Agreement for Off -site Activity A lease agreement is not required for raffles. <br />7. Rent <br />8. All <br />• <br />• <br />• <br />9. Lessor's <br />Print <br />to be paid for the leased area _ —. °^ __ If none, write "0." <br />obligations and agreements between the organization and the lessor are listed below or attached. <br />Any attachments must be dated and signed by both the lessor and lessee. <br />This lease and any attachments is the total and only agreement between the lessor and the organization <br />conducting lawful gambling activities. <br />Other terms, if any /V _27— <br />signature / ; t >�x,2. —" Date 'X-- °/ % /2-3 <br />lessor's na e _ Jim Morelan, Director <br />Little Canada Parks & Rec __ <br />515 Little Canada Rd. <br />Little Canada, MN 55117 r0 PAGE 2 <br />