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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 name LittleRecreation <br />515 Little Canada Rd <br />Address <br />county Ramsey <br />�8[�e���8�OOH� <br />Gambling manager name �'' <br />License number 34518 <br />city Little Canada MN Zip code 55117 <br />Daytime phone 6517755993 <br />1. Twelve off-site events are allowed each calendar year not to exceed a total of 36 days. <br />5 �8 15 5 2Q /15 <br />from/ /Ln � / <br />2. Check the type of games that will be conducted. <br />x raffle x pull -tabs bingo tipboards paddlewheel <br />3. Name of location where gambling activity will be conducted Old Fire Hall <br />4. County [where gambling activity will be conducted Ramsey <br />5. Street address and city [or township] 440 Little Canada Rd Little Canada Zip code 55117 <br />• Do riot use a postoffivabox <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 />No If no, the lease agreement below must be completed, and signed by the lessor. <br />7. Rent to be paid for the leased area If none, write "U." <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 gambUngaoUv|dea. <br />• Other terms, If any <br />9. Lessor's signature <br />Print lessor's name <br />� <br />CONTINUE TO PAGE 2 <br />Date 17/ �7 ��_ <br />