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FROM :
<br />FAX NO. :
<br />Minnesota Lawful Gambling
<br />LG215 Lease for Lawful Gambling Activit
<br />Apr. 06 2003 09:06PM P1
<br />8/03
<br />Page 1of2
<br />Name of legal owner of premises Sheet address City State Zip Daytime phone
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<br />Name of lessor Street address City State Zip Daytime phone
<br />(If same as legal owner, write in 'SAME")
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<br />Name of leased premises Street address City Zip Daytime phone
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<br />Narme of ressee (organization leasing the premises) Organization license number Daytime phone
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<br />Rent Information
<br />(for activity involving pull -tabs, tipboards, paddlewheels, and
<br />Rooth operation - sales of gambling equipment by an employee (or
<br />volunteer) of a licensed organization within a separate enclosure that is
<br />distinct from areas where toad and beverages are sold.
<br />Does your organization OR any other
<br />from a booth, operation at this
<br />L
<br />If you answered yes to the question above, rent limits are
<br />based on the following combinations of operation:
<br />- Booth operation
<br />- Booth operation and pull -tab dispensing device
<br />- Booth operation and bar operation
<br />Booth operation, bar operation, and pull -tab dispensing device
<br />The maximum rent allowed may not exceed $1,750 in
<br />total per month for all organizations at this premises.
<br />Complete one option:
<br />Option A: 0 to 10% of the gross profits per month-
<br />Percentage to be paid to %
<br />pull -tab dispensing devices, No lease required for raffles.)
<br />Sar operation - sales of gambling equipment within a leased
<br />premises by an employee of the lessor from a common area where
<br />food and beverages are al5d sold.
<br />organization conduct gambling
<br />location? Yes No
<br />If you answered No to the question above, rent limits are
<br />based oh the following combinations of operation._
<br />- Rar operation
<br />- Bar operation with pull -tab dispensing device
<br />- Pull -tab dispensing device only
<br />The maximum rent allowed may nit exceed $2,000 in
<br />total per month for all organizations at this premises.
<br />Complete one option:
<br />Option A: 0 to 20% of the gross profits per month.
<br />Percentage to be paid °la
<br />Option B: When gross profits are $4,000 or less per month, $0 to
<br />$400 per month may be paid. Amount to be paid $ -
<br />Option R: When gross profits are $1,000 or Tess per month, $0 to
<br />$200 per month may be paid. Amount to be paid $_
<br />Option ce $0 to $400 per month may be paid an the first $4,000
<br />of gi profit. Amount to be paid $ . Plus 0% to
<br />Option C: $0 to $200 per month may be paid on the first $1,000
<br />of gross profits. Amount to be paid.$ . Plus OXY% to
<br />10% of the gross profits may be paid per month on gross profits
<br />over $4,000. Percentage to be paid ___,_ _%
<br />20% of the gross profits may be paid per month on gross profits
<br />over $1,000_ Percentage to be paid
<br />,- _,.%
<br />NOTE: ! if there are any other terms or conditions for rent -related check all activities that will be conducted:
<br />expenses, they must be identified on page 2 under Acknowledgment X Pull -tabs Pull -tabs with dispensing device
<br />of Lease Terms and are subject to Board approval. Tipboards < Paddlewheel _,,,,,,Paddlewheel with table
<br />Rent Information:
<br />Bingo and/or Bar Bingo Occasions
<br />Rent for bingo and all other gambling activities
<br />conducted during a bingo occasion may not exceed:
<br />• $200 per occasion for up to 6,000 square feet
<br />* $300 per occasion for up to 12,000 square feet
<br />• $400 per occasion for more than 12,000 square feet
<br />ei $25 per occasion for bar bingo conducted at any time in
<br />bar (regardless of square footage)- Your organization
<br />must conduct another form of lawful gambling, and the
<br />raises must serve intoxicating liquor' or 31 percent
<br />malt beverages.
<br />Rent to be paid per bingo occasion $
<br />Bingo
<br />Noon Hour Bingo Occasions
<br />Rent may not exceed $25 per day for noon hour
<br />bingo conducted between 11 a.m. and 2 p.m. at a
<br />premises with a license for the sale of intoxicating
<br />beverages on the premises.
<br />a Rent to be paid per bingo occasion $
<br />r-1
<br />rQr any new bingo activity not previously
<br />i included in a Premises Permit Application, i
<br />I arch a separate sheet of paper listing the I
<br />days and hours that bingo will he conducted -
<br />L .1
<br />Amended If this is an es amended lease showing changes occurring
<br />that signed the lease must initial and date all dungen.
<br />Lease at least l4 days prior to the change_ Write in the
<br />Orlly Lessor Date Organization
<br />during the tem of the current premises permit, both parties
<br />Changes must be submitted to the Gambling Control Board
<br />date that the changes will be effective / / -
<br />05/03/04 20:12
<br />TX/RX N0.5674 P.001
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