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MINNESOTA LAWFUL GAMBLING <br />LG230 Application to Conduct Off-site Gambling <br />12/12 Page 1 of 2 <br />No Fee <br />Organization Information <br />Organization name Little Canada Recreation Assn. License number 34510 <br />Address 515 Little Canada Rd ow Little Canada MN Zip code 55117 <br />County Ramsey <br />Gambling 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 />2/1/14 <br />2. Check the gambling activity that will be conducted. <br />x raffle x pull -tabs bingo X tipboards paddlewheel <br />_. <br />Gambling Premises <br />3. Name of location where gambling activity will be conducted Gervais Lake <br />4. County (where gambling activity will be conducted Ramsey <br />5. Street address and city [or township] Edgerton Ave. &Little Canada Rd Zip code 55117 <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 />6. s your organization own the gambling premises? <br />Fell_ 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 to be paid for the leased area If none, write "0." <br />8. All 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 <br />9. Lessor's signature Date <br />Print lessor's name <br />CONTINUE TO PAGE 2 <br />