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CO 202(9189) . Lawful Gambling Lease Agreement • Premises Information Name of legal premises owner(lessor) Address Qty/Zip Code Phone Ct rV eF Sr. AV"ffwy 33o/ f t✓ex 4Aee ,Dan r,4V S341? Name of sublessor(it any) Address C4ty2ip Code hone Name and address of leased premises Address CityfZip Code h,40-14 CcJ&--LL.9 3 260 SILvOC /.AZEAeWb S-r,,lQr , , Y Name of organ¢a ion easing�omises S7. (losses) , Lcen�m�l A/77NyA/y y[u AGE 500,'500,'047S- At!!�WS EW S �•✓C . Gambling Activity The lawful gambling activity which the organization will conduct are(check all that apply): pbingo p raffles ppaddlewheels Cam] pull-tabs Otlpboards 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 ao. co 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 USG. 19 9d .and will end at 12:00 a.m.on 1 19 for a period of one year. Times and Days of Bingo Activity (11 none, indicate N/A) Q 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 (a.m./p.m.) on(days of week) from(hours) (a.m./p.m.) to (am./p.m.)on(days of week)