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Min.n.esota Lawful Gambling -5/06 ® Page I of 2 LG215 Lease for Lawful GamblActivity Check applicable Rem: X 1. Lease for new application. Submit with new premises permit application. 2. Renewed lease. Submit with premises permit renewal. 3. New owner. Submit new or amended lease within 10 days after new lessor assumes ownership. Date effective 4. Amended lease Check the change(s) in lease: Rent Premises name Booth/bar -Activity change Other Both parties must initial and date all changes. Submit changes at least 10 days prior to the change. Date that changes will be effective I J Organization name License number Daytime phone Lions Club of NE Minneapolis 02677 612-789-8171 Name of leased premises Street address city State Zip Daytime phone Village Pub 2720 Highway 88 St. Anthony M 55418 612-788-9680 Name of legal owner of premises Business/street address city State Zip Daytime phone Amcon St. Anthony, LLC 3120 Woodbury Drive #l0 Woodbury MN 55 125 651-735-2887 Name of lessor (if same as legal Business/street address city State Zip Daytime phone owner, write in "SAME") St. Anthony Restaurant Group, Inc. 2720 Highway 88 St. Anthony MN 55418 612-788-9680 Check all activities that will be conducted: X Pull-tabs Pull-tabs with dispensing device X Tipboards X Paddlewheel Paddlewheel with table Bingo Bar bingo Pull-tab, Tipboard, and Paddlewheel Rent (No lease required for raffles.) Booth operation - sales of gambling equipment by an employee Bar operation - sales of gambling equipment within a leased (or volunteer) of a licensed organization within a separate enclosure premises by an employee of the lessor from a common area where that is distinct from areas where food and beverages are sold. food and beverages are also sold, — — — — — — Does your organization OR any other organization condoct, gambling L _..w .� ..yfrom a booth operation at this location? Yes No .._. ___. ___. ._...__. �. -J If you answered to the question above, rent limits are If you answered to the question above, rent limits are based on the following combinations of operation: based on the following combinations of operation: - Booth operation I - Bar operation - Booth operation and pull-tab dispensing device - Bar operation with pull-tab dispensing device - Booth operation and bar operation - Pull-tab dispensing device only - Booth operation, bar operation, and pull-tab dispensing device The maximum rent allowed may not exceed $1,750 in total The maximum rent allowed may not exceed $2,500 in total per month for all organizations at this premises, per month for all organizations at this premises. Complete one option: Complete one option: Option A: 0 to 10% of the gross profits per month, Option A: 0 to 20% of the gross profits per month, Percentage to be paid _% Percentage to be paid % Option B: When gross profits are $4,000 or less per month, $0 to Option B: When gross profits are $1,000 or less per month, $0 $400 per month may be paid. Amount to be paid $ a to $200 per month may be paid. Amount to be paid $ Option C: $0 to $400 per month may be paid on the first $4,000 Option C: $0 to $200 per month may be paid on the first $1,000 of gross profit. Amount to be paid $ 400 plus o% to of gross profits. Amount to be paid $ a Plus 0% to 10% of the gross profits may be paid per month on gross profits 20% of the gross profits may be paid per month on gross profits over $4,000. Percentage to be paid 10 % over $1,,000. Percentage to be paid % Bingo Rent Bar Bingo Rent Option D: 0 to 10% of the gross profits per month from all lawful T Option F: No rent may be paid for bingo gambling activities held during bingo occasions, excluding bar bingo. conducted in a bar, Percentage to be paid .% Option E: A rate based on a cost per square foot not to exceed 110% of a comparable cost per square foot for leased space, as approved by New Bingo Activity the director of the Gambling Control Board. No rent may be paid for bar bingo. Rate to be paid $_ per square foot. For any new bingo activity not previously The lessor must attach documentation,, verified by the organization, to included in a Premises Perm It Application, confirm the comparable rate and all applicable costs to be paid by the attach a separate sheet of paper listing the organization to the lessor. days and hours that bingo will be conducted. W