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• <br />Minnesota Lawful Gambling <br />Lease for Pull -Tab, Paddlewheel, Ti board and/or Raffle Activity - L <br />Name of Legal Owner of Premises Street Address City Zip <br />Ak-fh- 2ro111?Xs, Inc 6001 /1 4 S o& 7 2 d Z-#'.11-6 L a .s SS°j Li <br />Daytime Phone <br />( C SI ) `/$ Y - /US <br />Name of Lessor Street Address City Zip <br />(If same as legal owner, write in "SAME ") <br />SGvOe <br />Daytime Phone <br />( ) <br />Name of Leased Premises Street Address City Zip <br />-Mt Lic CIt410 6007 H0d5sarl Rd L,hoLAke3 SSoiy <br />Daytime Phone <br />(6s/ )Y8y -9985 <br />Daytime Phone <br />(6/a )3aa, -aa52 <br />Name of Lessee (name of organization leasing the premises) GCB license no. of organization <br />r(ivW tSo1c /USIA kiresflIhc, )IMc O3071 -1 <br />Rent Information <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 />• 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 $ / U 0 U cr-u <br />(lino rent is to be paid, indicate -0-) <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 / c� <br />The leased areas are: tD feet by D feet for a total of Li <br />or Premises Permit Renewal Applications 0 <br />6#6010411444,41-r4617 <br />cb#he site, you'da n� <br />t 6 rye�i� v4 Nz d �5M' N • <br />cam let 'trhts secflan or prorride a sketch. <br />Agonnowashoi, <br />Storage <br />Storage <br />feet by feet for a total of <br />feet by feet for a total of <br />feet by feet for a total of <br />feet by feet for a total of <br />Combined total <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />square feet. <br />Lawful Gambling Activity <br />Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br />X Paddlewheels l` Pull -Tabs <br />X Raffles <br />X Tipboards <br />Term of Lease <br />Amended Lease Only <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 />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 />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 />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 />governing lawful gambling activities. <br />Page 1 of 2 <br />1/99 <br />