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~ r ......:..::::::; '~~''` RENTAL AGREEMENT ~ :. 1 '' OFFICE OF ATTORNEY GENERAL ~'~" ";): '• •, i ~o` SFN 9413 (Rev. 010-2006) '~ '. ,. pp NpRTH ~ STATE USE ONLY SITE LICENSE NO. G-----~---~- Site Ownper (Lessor) J d i C V ~~ ~~ F ~ Site Name Site Phone Number ?n 2~~^2 2co ' I~Q r r 5sct ~R - Q ~~~ ~ i . ~- ~ ite Address Cie`ty '~ [^ ~ Q ~ p Stat ,/~ ~ Zip CCode U ~~ ~ County ~ ~ ~ S V~/~. 5 f p U J D . Organization (Lessee) C~.ss ~our~ I,~111;~ C1k~ Rental Period _ ~ .-,~~- la t° /-~~/-Jc~ AAeAtt~Iy.Rent Amount .~,„u~ ~ , Is Bingo the primary game conducted? if "Yes,"answer questions 2 - 7 but do not enter rent _~ No ~ Yes a t f ti 7 3 $ moun s or ques ons . - 2. Is Bingo involving a dispensing device conducted? ~ No ~ Yes $ -- 3. Is Twenty-One conducted? ~ No ~ Yes $ r- Number of Tables with wagers up to $5 X Rent per Table $ Number of Tables with wagers over $5 X Rent per Table $ $ 4, Is Paddlewheels conducted? X Rent per Table $ ~ No ~ Yes $ Number of Tables 5, Is Pull Tabs involving both a jar bar and dispensing device conducted? " " No ~ Yes $ If Yes, skip questions 6 & 7. 6. Is Pull labs involving only ajar bar conducted? ~ No ~ Yes $ _7._ .-Ls_Pull Tabs involving ony a dispensing device conducted on this site? _ __ ~ No ~ Yes $ _.,. Total~~7~ent $ nrtlt TERMS OF RENTAL AGREEMENT: This RENTALAGREEMENT 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 lessor's business. The LESSOR agrees that the (lessor), (lessors) spouse, (lessor's) common household members, (management), (management's) 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 officers 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 -_T__ _-__ -,- - bingo card involving a dispensing device and sell raffle tickets or sports pool chances on a board on behalf of an organization. The LESSOR agrees that the lessor's oncall 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 entire loan immediately when-the Jessee discontinues using the device at the site. -he-L-ESSOR-agrees-not to interfere-with or attempt-to-influence the lessee's selection of games, determination of prizes, including 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 op ' t I ssee agrees that_this rental agreement maybe automatically terminated if the lessee's gaming license is suspended at this site - - - _._ - for mcre than fcu er, d ~ , re ked. ` " - - I _ - _ - _ --- - --- i -- -- ------------ - - _---- -- --- - _ - to _ - - -- --_ - - -- - J _ ~/ i~'o Signature of Lesse Top Execu6 iciaq (,;>..~, Title ~r ;~S ~ C~~ rJ - Dot (over)