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MINNESOTA LAWFUL GAMBLING <br />LG230 Application to Conduct Off-site Gambling <br />5/13 Page 1 of 2 <br />No Fee <br />Organization Information <br />l c> <br />Organization name L'7T 4 a4'�h,»'1)/,A�/i7t�r;� License number (:*-/ Y <br />„Lg�-.r'r �'4 <br />Address 5./,— ,- L/QE �14ti/n!'4 ' l24 aty L/(�E c r7/ti¢'L)4 MN Zip code 3:4;7/ 7 <br />County RAM5EX <br />rig / a / / j <br />Gambling manager name D C2/ / ne/e6,418?0 Daytime phone 4,5 / —57 77 —/ S. }`�� <br />/ <br />Gambling Activity <br />1. Twelve off-site�f events /are allowed each calendar year not to exceed a total of 36 days. <br />from h / / / /1• to 5-/ 3/ ) <br />2. Check the type of games that will be conducted. <br />raffle V''' pull -tabs ✓bingo tipboards paddlewheel <br />Gambling Premises <br />�7 P j <br />3. Name of location where gambling activity will be conductfd /' 01 .,e /L. <br />4. County [where gambling activity will be conducted /l4y12`-1"a <br />5. Street address and city [or township] Zip code <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. Does your organization own the gambling premises? <br />Yes If yes, a lease is not required. <br />V 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 /0 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 />5/o ,U6/C Mick__�cw/'' Al C//TL �-r I!_ - /d 1 al -1711 <br />4_ <br />9. Lessor's signature "7,776-7-0---r----"7,776-7-0---r---- Date / /G/ / X24 <br />Print lessor's nam v7 Ai 9E 1 i1Y <br />,✓7i0,e <br />CONTINUE TO PAGE 2 <br />