01/25/1999 Council Packet - Laserfiche WebLink

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Minnesota Lawful Gambling Lease for Pull -Tab, Paddlewheel, Tipboard, and/or Rattle Activity - LG221 Name of Legal Owner of Premises Street Address City Zip Daytime Phone 5hiriEq kaye Moore 6 W Laken LIh. e Lai'es /11/v' 5Z isi (GS'i ) 71a-We/ Name of Le or Street Address City Zip Daytime Phone (If same as legal owner, write in "SAME ") OLielet e. ( ) Name of Leased Premises Street Address City Zip Daytime Phone Sh,'4e ka cs 5 orfs gar (QS10 l-xieeLD,' Linoktees sso /Y((Ps/ )780 - 8/ Name of Lessee (namerof organization leasing the,mises) GCB license no. of organization Daytime Phone Centenlnt`at markt ttoc cey Assn. B- 03931- 003 (Gs/ )786-3„21q Rent Information • Total rent cannot exceed $1,000 per month for all non -bingo activity for this premises. • For bingo activity, use lease form LG222. • For pull -tab dispensing machines, use lease form LG223. • An organization may not pay rent to itself or to any of its affiliates for space used for the conduct of lawful gambling. Rent to be paid per month $ 700 O. 00 (If no rent is to be paid, indicate -0-) Sketch and Dimensions of Leased Area Sketch: For all areas being leased for the conduct of gambling and storage of gambling product at this premises, attach a sketch (drawing) showing: (1) the leased area(s), and (2) the dimensions. Dimensions The leased areas are: Storage Storage o feet by feet by feet by feet by feet by PRIS feet for a total of square feet. feet for a total of square feet. feet for a total of square feet. feet for a total of square feet. feet for a total of square feet. Combined total square feet. Lawful Gambling Activity Type of gambling activity that will be conducted at this gambling premises. Check all that apply. i( Paddlewheels �` Pull -Tabs K Raffles i(� Tipboards Term of Lease Amended Lease Only The term of this lease agreement will be concurrent with the premises permit issued by the Gambling Control Board, unless terminated sooner by mutual consent of the lessor and lessee. If this is an amended lease showing changes occurring dur- ing the term of the current premises permit, write in the date that the changes will be effective / / Both parties that signed the lease must initial and date all changes. Questions on this form should be directed to the Licensing Section of the Gambling Control Board at 651- 639 -4000. This publication will be made available in alternative format (i.e. large print, Braille) upon request. Hearing impaired individuals using a TTY may call the Minnesota Relay Service at 1 -800- 627 -3529 and ask to place a call to 651- 639 -4000. The information requested on this form will be used by the Gambling Control Board (Board) to determine your compliance with Minnesota statutes and rules goveming lawful gambling activities. All of the information that you supply on this form will become public information when received by the Board except, if required, your Social Security number, which remains private. Page 1 of 2 Rev. 7/98