a. Site authorization permits - Laserfiche WebLink

RENTAL AGREEMENT STATE USE ONL V OFFICE OF ATTORNEY GENERAL SITE LICENSE NO. SFN 9413 (Rev. 010-2006) G- ----(---)- Site Phone Number o/-34-7-'-I4I! ~S to Morb~~mount 1. 5SI No Yes $ 2. Is Bingo Involving a dispensing device conducled? lYJ No Yes $ 3. Is Twenty-One conducled? ~ Number of Tables with wagers up to $5 X Rent per Table $ No Yes $ Number of Tableswith wagers over $5 X Rent per Table $ $ 4. Is Paddlewheels conducled? 1KJ D Number of Tables X Rent per Table $ No Yes $ 5. Is Pull Tabs involving both a jar bar and dispensing device conducted? lXJ No D Yes $ If "Yes," skip questions 6 & 7. 6. Is Pull Tabs involving only a jar bar conducled? !Xl No D Ves $ 7. Is Pull Tabs involving only a dispensing device conducted on this site? D No ~ Yes $ 100 Total Monthly Rent TERMS OF RENTAL AGREEMENT: $ /()O This RENTAL AGREEMENT is between the Owner (LESSOR) and Organization (LESSEE) that will be leasing the site to conduct games of chance. The LESSOR agrees that no game will be directly operated as part of the Iessor's business. The LESSOR agrees that the (lessor), (Iessor's) spouse. (lessor's) common household members. (management), (managemenfs) spouse, or an employee of the lessor who is in a position to approve or deny a lease may not conduct games at any of the organization's sites and, except for ofIicers and board of directors members who did not approve the lease, may not play games at that site. However. a bar employee may redeem a winning pull tab or bingo card involving a dispensing device and sell raffte tickets or sports pool chances on a board on behalf of an organization. The LESSOR agrees that the Iessor's oneall or temporary or permanent employee will not, directly or indirectly, conduct games at the site as an employee of the lessee on the same day the employee is working in the area of the bar where alcoholic beverages are dispensed or consumed. If the LESSEE provides the Lessor with a temporary loan of funds for redeeming pull tabs or bingo cards. or both. involving a dispensing device. the Lessor agrees to repay the entIN loan Immediately when the lessee discontinues using the device at the site. The LESSOR agrees not to interfere with or attempt to inlluence the lessee's selection of games, determination of prizes, induding a bingo jackpot prize, or disbursement of net proceeds. The LESSOR agrees not to loan money to. provide gaming equipment to, or count drop box cash for the lessee. At the LESSOR'S option, the lessee agrees that this rental agreement may be automaticaHy terminated if the lessee's gaming license is suspended at this site for more than fourteen days or rewked. ( 3/x/y Date f7. (over)