2009 (2)COMPUTATION OF LICENSE FEES
4
COLLECTED BY MUNICIPAL CLERK
~ WITH RESPECT TO GAMES OF CHANCE AND BINGO
X L lOR
MUNICIPAL CLERK ANNUAL REPORT
Please provide the municipal clerk's name, address and name of municipality. ~ "" ~
-,~,
NAME: John C Ma terson ( ~/
ADDRESS: 20 Middlebush Rd Wa~~ingerG Fal l G, NY 12 90
NAME OF CITY, TOWN R VILLAGE: Wa~pinger
(Circle one of the above.
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6,
I . Total Number of Licenses Issued:
2. Total Amount of License Fees Collected: $
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1. Total Number of Organizations Conducting Raffles:
2. Total Number of Raffles Conducted:
'For Raffles Exceeding, $30.000 in Net Proceeds:
l . Total Receipts (Line A3 of GC-7R) $
2. Total Net Profit (Line CS of GC-7R) $
3. Total Amount of License Fees Collected: $
4. Total Amount of Additional License Fees Collected: $
For Raffles Exceeding $5,000 Net Proceeds or between $20,000 and $30 000 in
Cumulative Net Proceeds:
1. Total Receipts (Line A3 of GCVS-2) $
2. Total Net Profit (Line Cl of GCVS-2) $____
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l . Total Number of Organizations Conducting GOC:
2. Total Number of GOC License Periods:
3. Total Receipts (Line A4 of GC-7): $
4. Total Net Profit (Line C3 of GC-7): $
5. Total Amount of License Fees Collected: $
6. Total Amount of Additional License Fees Collected: $
NYS Racing and Wagering Board 1 Broadway Center, Suite 600, Schenectady, NY 12305-2553
Telephone: (5 ] 8) 395-5400, Fax: (518) 347-1469
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1. Total Number of Organization Conducting Bingo:
2. Total Number of Occasions:
3. Total Number of Players:
4. Total Receipts (Line A4 of BC-7Q): $
5. Total Net Profit (Line C3 of BC-7Q): $
6. ToiaTAmount ofLicense Fees Collected: $
7. Total Amount of Additional License Fees Collected: $
Total Number of Licenses Issues:
Total Number ofLicense Fees Collected:
I swear or affirm that the information and statements contained herein have been examined by me and to the best of my
knowledge and believe are true, correct and complete.
`~ '~ ~~ ~ ' ~ ' ,Y.~ John C. Masterson Town Clerk Old 04~ 2010
Signature Print Title Date
FOR OFFICIAL USE ONLY
Municipal Code
Entered By
Date F,ntered
1. Total Number of Organization Conducting Bingo:
2. Total Number of Occasions:
3. Total Number of Players:
4. Total Receipts :(Line A4 of BC-7Q): $
5. Total Net Prot (Line C3 of BC-7Q): $
6. Total Amount-of License Fees Collected: $
7. Total Amounf of Additional License Fees Collected: $
1. Total Number'of'Licenses`Issues:
2. Total Number of'License.Fees Collected: $
I swear or affirm that the information and statements contained herein have been examined by me and to the best of my
knowledge and believe are true, correct and complete.
' John C. Masterson Town Clerk O1~ 04~ 2010
Signature Print Title Date
FOR OFFICIAL USE ONLY.
Municipal Code
Entered By
Date .Entered
BINGO AND GOC WORKSHEET
License Year: 2009 Occasion Dates: 1 /1 /2009 to 12/31 /2009
BINGO ACTIVITY
'3PLrZ~~
1. Number of organizations conducting-Bingo Games 0
2. Number of Bingo occasions 0
3. Total number of players 0
4. Total Bingo receipts $0.00
5. Total Bingo net profit $0.00
6. Amount of Bingo License fees collected $0.00
7. Amount of Additional License fees collected.''. $0..00
COMMERCIAL LESSORS
8. Number of Commercial Lessor Licenses =-issued 0
9. Amount of Commercial Lessor License fees collected $0.00
GAMES OF CHANCE (GOC) ACTIVITY
GOC (CASINO, VEGAS, FIELD DAY, ECT.) EVENTS
10. ``°Number of organization _conducting GOC 1
11. Number of GOC periods 0
12. 'Number of GOC receipts $0.00
13. Number of GOC net profit $0.00
14. Amount of GOC License fee collected $125.00
15. Amount of GOC Additional License fees collected $0.00
RAFFLES
16. Number of organizations conducting Raffles 0
17. Number of Raffles conducted 0
18. Total Raffle receipts $0.00
19. Total Raffle net profit $0.00
20. Amount of Raffle License fees collected ' $0.00
21. Amount of Raffle Additional License fees collected $0.00
BELL JAR
22. 'Number of organizations conducting Bell Jar 2
23. Amount of Bell Jar Licenses collected $50.00
Chairman Executive Director
John D. Sabini Ronald G. Ochrym
Members STATE OF NEVV YORK Secretary to the Board
Daniel D. Hogan RACING AND WAGERING BOARD Gail Pronti
John B. Simoni
TO: ALL MUNICIPAL CLERKS
RE: ANNUAL REPORT ON BINGO/GAMES OF CHANCE ACTIVITIES
DATE: December l8. 2009
Pursuant to Section 439-a of the Executive Law, each municipality with a local law is required to
submit a report of their Games of Chance and Bingo statistics on or before February ISM of each
year. The information provided will be included in the Racing and Wagering Board's (the
Board) Annual Report submitted to Governor Paterson and the State Legislature.
PLEASE NOTE: If your municipality has not had any reportable activity for the past year, please
write "No Activity" on the enclosed form and return it to the Board. Reporting no activity is
important because it allows us to track statewide trends in charitable gaming.
Your cooperation and compliance is essential to the efficient supervision of gaming activities
statewide. The enclosed form may be completed and faxed to(518) 347-1469 or mailed to the
attention of the Charitable Gaming unit at the address listed below. If you have any questions,
please contact our office at (518) 395-5400 extension 1305.
XXSubmission Deadline: February 1, 2010~~
Xc L6104 '
1 Broadway Center, Suite 600, Schenectady, NY 12305-2553
Telephone: (518) 395-5400 Fax: (518) 347-1469
http://www.racing.state.ny.us
S e n d i n g C o n f i r m
Date : JAN-4-2010 MON 01:34PM
Name TOWN CLERK
Tel. (845}298-1478
Phone
Pages
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Elapsed Time
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Result
15183471469
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O1-04 01:31PM
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ECM
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