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D.5 <br />MINNESOTA LAWFUL GAMBLING 6/15 Page 1 of 2 <br />LG230 Application to Conduct Off -Site Gambling No Fee <br />ORGANIZATION INFORMATION = <br />Organization Name: Merrick, Inc. <br />Address: 3210 Labore Road <br />Chief Executive Officer (CEO) Name: John W. Barker <br />License Number:00264 <br />City: Vadnais Heights , MN Zip: 55110 <br />Daytime Phone: 651-789-6200 <br />Gambling Manager Name: Wendy L. Busch _ Daytime Phone: 651-238-6871 <br />GAMBLING ACTIVITY <br />Twelve off -site events are allowed each calendar year not to exceed a total of 36 days. <br />Fromm 24 / 18 to 91 24 / 18 <br />Check the type of games that will be conducted: <br />Raffle ❑Pull -Tabs Bingo ❑Tipboards ❑Paddlewheel <br />GAMBLING PREMISES <br />Name of location where gambling activity will be conducted: American Legion Post 620 <br />I <br />Street address and <br />1 City (or township): 538314OTh Street N., Hugo Zip: 55038 County: <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 />❑Yes If yes, a lease is not required. <br />I <br />ENo 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 not required for raffles) <br />Rent to be paid for the leased area: $0 (if none, write "0") <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: <br />Print Lessor's Name: <br />CONTINUE TO PAGE 2 <br />Date: <br />