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LGM Minnesota Lawful Gambling <br /> (o9ias/ssl <br /> LEASE AGREEMENT FOR <br /> PULL-TAB, PADDLEWHEEL, TIPBOARD, AND/OR RAFFLE <br /> ACTIVITY AT A PERMITTED PREMISES <br /> c P►roperiy OwxerlLej:3 r Fnformat:on �, �1�% <br /> ry <br /> .. <br /> r.�' .J <br /> Name of Legal Owner of Property Street Address ty Zip Daytime Phone <br /> S?r P'9 J�`�l►oit'1 <br /> S` 1 4-M or, Sr kr yi.F (&2) 731�-88 E� <br /> Name of Lessor Street Address City Zip Daytime Phone <br /> (This may or may not be the same as the Legal Owner of the Property) <br /> SRMC— as #Lof C- c ) <br /> Name of Leased Premises /. Street Address City Zip Daytime Phone <br /> / r VaZL�� �.t3ril �S C� Sr��rr C_c'1— GJ• <br /> y ( ) <br /> Name of Lessee(Name of Organization Leasing the premises) GCB License#of Organization Daytime Phone <br /> 1P16�%f"9 rR�, eI�n"t II nr foVrri. I� &OI �'L I�r <br /> - - &E' <br /> /o� <br /> rm� I 2 <br /> i <br /> Type of gambling activity(check all that apply)that will be conducted at this gambling premises. ` <br /> 0 Raffles , Q Paddlewheels Pull-tabs Tipboards <br /> • Total rent cannot exceed $1,000 per month for all non-bingo lease agreements with your organization for this gambling premises. <br /> An organization may not pay rent to itself or to any of its affiliates for space used for the conduct of lawful gambling. <br /> Rent to be paid per month S 800 <br /> List dimensions of all area leased by your organization for the conduct of gambling activity checked above,including storage. <br /> r <br /> The leased areas are: feet by / feet for a total of oZ square feet. <br /> feet by feet for a total of square feet. <br /> feet by feet for a total of square feet <br /> feet by feet for a total of square feet <br /> Storage feet by feet for a total of square feet <br /> Storage feet by feet for a total of square feet <br /> Combined total 4 L square footage <br /> Submit a sketch(drawing)of the gambling premises. This must show the location of your organization's leased area(s) for the conduct <br /> of lawful gambling,including areas leased for storage of your gambling product on this gambling premises. Be sure to write the dimensions <br /> of the leased areas on the sketch. THE DIMENSIONS ON THE SKETCH MUST BE THE SAME AS THOSE USM ABOVE. <br /> MN Statute 349.18 Subd 1 states that the term of the lease may not begin before the effective date of the premises permit and must expire <br /> • on the same day that the premises permit expires. ONLY write an cft'ective date in this area of the lease if this is a renegotiated lease <br /> agreement oecuring during the term of your current premises permit <br /> Effective Date for Amended Lease Agreements �_ <br />