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6.5 <br />MINNESOTA LAWFUL GAMBLING 6/15 Page 1 of 2 <br />LG230 Application to Conduct Off -Site Gambling No Fee <br />ORGANIZATION' I. <br />N FORMIATIO N <br />Organization Name: Bayport American Legion Post 491 License Number: 00467-01 l <br />Address: 263 N. 3rd St. _ City; Bayport _ MN Zip: 55003 <br />Chief Executive Officer (CEO) Name: Thallassa Gunelius <br />Gambling Manager Name: William Burtzlaff <br />Daytime Phone: 651-285-1306 <br />Daytime Phone: 651-332-4751 <br />GAMBLING ACTIVITY <br />Twelve off-site events are allowed each calendar year not to exceed a total of 36 days. <br />From 2/18/18 to 2 / 18 / 18 <br />Check the type of games that will be conducted: <br />Raffle Pull -Tabs FVBingo ❑Tipboards Paddlewheel <br />GAMOLING PREMISES <br />Name of location where gambling activity will be conducted: Hugo American Legion Post 620 <br />Street address and <br />City (or township): 5383 140th St N, Huao, MN_ Zip; 55038 County: WA <br />• Do not use a post office box. <br />• If no street address, write in road designations (example: 3 miles east of Hwy. 63 on County Road 42). <br />Does your organization own the gambling premises? <br />F]Yes If yes, a lease is not required. <br />❑✓ No If no, the lease agreement below must be completed, and signed by the lessor. <br />LEASE AGREEMENT FOR`OFF-SITE ACTIVITY (a lease agreement is ndt`reoLdred &o r.6ffies) <br />Rent to be paid for the [eased area: $ 0 _ (if none, write "0") j <br />I <br />All obligations and agreements between the organization and the lessor are listed below or attached. <br />• Any attachments must be dated and signed by both the lessor and lessee. <br />• This lease and any attachments is the total and only agreement between the lessor and the organization conducting lawful <br />gambling activities. <br />• Other terms, if any: <br />Lessor's Signature: Date: <br />Print Lessor's Name: <br />CONTINUE TO PAGE 2 <br />