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1. NAME OF CONGREGATION, CAMPGROUND, OR MISSION CENTER REQUESTING THE LEASE. 2. ADDRESS OF PROPERTY BEING LEASED. Address: City: S tate: Zip C o de 3. PROPERTY BEING LEASED IS A: C hurch acility f R esiden tial prop erty P ark ing ot l Other: 4. CHURCHíS CONTACT PERSON Name: Office (Pastor/FinOanffciciaelr ): Address: City: State: Zip Code Telephone umbenr: Fax num ber: E-mail: 5. TENANTíS NAME AND CONTACT INFORMATION Name Address: Office he ld: City: State: Zip Code Telephone umbenr: Fax num ber: E-mail: 6. INTENDED USE BY TENANT: (Example: religious, educational, day care, personal business) 7. TYPE OF BUSINESS: NON PROFIT FOR PROFIT 8. DEPOSIT AND MONTHLY RENT TO BE CHARGED. Deposit: $ Rent: $ Page 1 of 2 9. WHICH PARTY WILL BE RESPONSIBLE FOR UTILTIES? (Consider how the increase in utilities due to additional use by tenant will be paid.) Congregation Campground Mission Center Ten ant 10 REQUESTED START DATE (effective date) FOR THE LEASE. 11 TERM OF THE LEASE (i.e. month to month, 6 months, 1 year) 12 DOES THE TENANT MEET THE CHURCHíS INSURANCE REQUIREMENTS? YES NO NOTE: Tenant will be required to provide a Certificate of Insurance to Risk Management for review and approval, prior to having access to the property. Sexual Abuse and Molestation coverage is required for groups using a facility that involve children in any way. 13 DETAILED DESCRIPTION OF THE TENANTíS RIGHT TO ACCESS THE PROPERTY. (Designate and be specific) Days peek:r we Hours per day: to Parking spaces: Storage area: Rooms: 14 KEYS. Number of sets of keys to be delivered to Tenant . Name of Person receiving keys on behalf of Tenant: 15. DOES TENANT HAVE MAINTENANCE AND CLEANING RESPONSIBILITIES? YES NO If yes, please de scribe