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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: American Lecion Post 620 _ License Number: 00905 <br />Address: 5383 140th Street N City: Hugo MN zip: 55038 <br />Chief Executive Officer (CEO) Name: Greg Burmeister Daytime Phone: 651-503-1834 <br />Gambling Manager Name: William Delaney Daytime Phone: 651-470-0901 <br />GAMBLING ACTIVITY <br />Twelve off -site events are allowed each calendar year not to exceed a total of 36 days. <br />From 06 / O8 / 19 to 06 / 09 / 19 <br />Check the type of games that will be conducted: <br />❑ Raffle ❑Pull -Tabs ✓❑Bingo ❑Tipboards El Paddlewheel <br />GAMBLING PREMISES <br />Name of location where gambling activity will be conducted: Lions Park <br />Street address and <br />City (or township); 5524 Upper 146th Street, Hugo MN Zip; 55038 County: Washin ton <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 />�✓ 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 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: Date: <br />Print Lessor's Name: <br />CONTINUE TO PAGE 2 <br />