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MINNESOTAi LAWFUL GAMBLING 6/15 Page a of 2 <br />LG230 Application to Conduct Off -Site Gambling No Fee <br />_VRISANIZATION INFORMATION <br />Organtzation Name: Merrickr Inc. License Number•L264 <br />Address: 3210 Labors Road city: Vadnals Heights MN Zip: 55110 <br />Chief Executive Officer (CED) Name: John W. Baricer Daytime Phone: 651-789-4200 _w <br />Gambling Manager Name: Wendy L. Bustti_.�.. Daytime Phone: 651-238-6671 <br />p K3AmEi.IrlG ACTJEYtiY <br />Twelve off -site events are allowed each calendar year not to exceed a total of 36 days. <br />From —LI1 to <br />It 42& <br />Check the type of games that will be conducted: <br />�Raffle E]Pult-Tabs ElBingo ElTipboards F]Paddiewheel <br />1GiAirIBLIWf"ii P"REM" <br />Name of location where gambling activity will be conducted: Nino American Legion Post 620 <br />Street address and <br />City (or township): 5383 140th Street N. 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 regained. <br />(Eft If no, the lease agreement below must be completed, and signed by the lessor. <br />LEM AGREEMENT FOR OFF-S 'E d4CTMTY (a lease agreement is not regulred for raw _ s <br />Rent to be paid for the leased area. $A __._.., .. (if none, write 00") <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 temtis, if any: <br />I z <br />Lessor's Signa re <br />jPrint Lessor's Name; <br />COPMNUE TO PAGE 2 <br />Date: <br />