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I J CG 202(9/89) Lawful Gambling Lease Agreement • Premises Information Name of legal premises owner(lessor) Address City2ip Code Phone Cl ry' eF Sr.J t4rNtwy 33ol f t✓rx 4Ae-e ,A o Ste/? W Fffl/ Name of sublessor(it any) Address City/Zip Code hone Name and address of leased premises Address ip Code XX40-14-i97GJri.t_s 3 boo S/,Lv&x. 1,,4eE 6%D ST. 55S¢z Name ot organization leasing the premises(lessee) nse NUmoer,it Known S7_ 4T7,tvAy V(4L AGE 5,A'047Y At--fV,-7W S ��✓C Gambling Activity The lawful gambling activity which the organization will conduct are(check all that apply): pbingo praffles Opaddlewheels pull-tabs Otipboards Rent Information (See Rules 7860.0090,Subp 3) Class A and C licenses: Class B and D licenses: Rent for bingo and all other gambling activities conducted Rent for gambling activities not including bingo during that bingo occasion may not exceed: may not exceed$24 per square foot per month, $200 for up to 6,000 square feet; - with a maximum of$600. $300 for up to 12,000 square feet;and $400 for more than 12,000 square feet. • Rent to be paid per bingo occasion $ Rent to be paid per month $ /0 od. Cb Rent may not be based on a percentage of receipts or profits from lawful gambling. Premises Description The area leased within the premises is feet by feet,for a total of square feet. Attach a sketch which identifies the location of the leased premises when a portion of a building is the leased premises. That sketch must include the dimensions of the leased premises. Effective Dates The lease will go into effect at 12:01 a.m.on DEG 19 and will end at 12:00 a.m.on ! 19 for a period of one year. Times and Days of Bingo Activity ("none,indicate N/A) p N/A The bingo occasions will be held: from(hours) (am./p.m.) to (am./p.m.) on(days of week) from(hours) (a.m./p.m.) to (am./p.m.)on(days of week) from(hours) (a.m./p.m.) to (am./p.m.) on(days of week) from(hours) (a.m./p.m.) to (am./p.m.)on(days of week) • from(hours) (a.m./p.m.) to (am./p.m.) on(days of week) from(hours) (a.m./p.m.) to (am./p.m.)on(days of week)