Laserfiche WebLink
,r - . W - <br /> Minnesota Lawful Gambling <br /> Lease for Pull-Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 <br /> Name of Legal Owner of Premises Street Address City Zip Daytime Phone <br /> City of St .Anthony 3301 Silver Lk Rd St .Anthony 55418 ( 512 ) 789-8881 <br /> Name of Lessor Street Address City Zip Daytime Phone <br /> (If same as legal owner,write in"SAME") <br /> SAME ( ) <br /> Name of Leased Premises Street Address City Zip Daytime Phone <br /> Stonehouse 2700 Highway 88 St . Anthony 55418 ( ) 781 -4122 <br /> Name of Lessee(name of organization leasing the premises) GCB license no.of organization Daytime Phone <br /> St AnthonyVillaae — ( ) 789-07311 <br /> Rent Information <br /> • Total rent cannot exceed $1,000 per month for all An organization may not pay rent to itself or to <br /> non-bingo activity for this premises. any of its affiliates for space used for the conduct <br /> • For bingo activity, use lease form LG222. of lawful gambling. <br /> • For pull-tab dispensing machines, use lease form <br /> LG223. <br /> Rent to be paid per month $-900.00 per mo. <br /> (If no rent is to be paid,indicate-0-) <br /> Sketch and Dimensions of Leased Area <br /> Sketch: For all areas being leased for the conduct FoiVremises"Peirmit Reniwal'Applicatiorls',OnIV.,tlf,no, <br /> of gambling and storage of gambling product at this <br /> 9 9 9 9 9 P changes'have,been madeatthestte;you do not have-to'": <br /> premises, attach a sketch (drawing) showing: 1 the p p' <br /> ( 9) 9 O coni lege tlifs.'section''or rovtde`a sketch: <br /> leased area(s), and (2) the dimensions. <br /> Dimensions <br /> The leased areas are: 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 square feet. <br /> Lawful Gambling Activity <br /> Type of gambling activity that will be conducted at this gambling premises. Check all that apply. <br /> Paddlewheels _Pull-Tabs Raffles Tipboards <br /> Term of Lease Amended Lease Only <br /> The term of this lease agreement will be concurrent with the If this is an amended lease showing changes occurring dur- _. <br /> premises permit issued by the Gambling Control Board, ing the term of the current premises permit, write in the <br /> unless terminated sooner by mutual consent of the lessor date that the changes will be effective <br /> and lessee. Both parties that signed the lease must initial and date all <br /> changes. <br /> Questions on this form should be directed to the Licensing The information requested on this form will be used by the <br /> Section of the Gambling Control Board at (612) 639-4000. Gambling Control Board(Board)to determine your compliance <br /> This publication will be made available in alternative format with Minnesota statutes and rules goveming lawful gambling <br /> •(i.e. large print, Braille) upon request. Hearing impaired activities. All of the information that you supply on this form = <br /> individuals using a TTY may call the Minnesota Relay Service will become public information when received by the Board <br /> at 1-800-627-3529 and ask to place a call to(612)639-4000. except,if required,your Social Security number,which remains � . <br /> private. <br /> Page 1 of 2 <br /> Rev. 8/97 <br /> ;1 <br /> :cn:- <br />