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NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
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FINDINGS AND
DETERMINA TION
FOR GAl\1ES OF CHANCE
LICENSE
GC - IT] - [II] - [II] - [D:=IIJ
N.Y.S. Identification Number
Name of Municipality
Address
After investigation, and a hearing ifrequired under Sec. 192 of the General Municipal Law, the following findings and determinations
have been made:
1. All the members-in-charge designated in the application to conduct games of chance are of good moral DYes 0 No
character and have never been convicted of a crime.
Signature of Person Conducting Investigation'
Title
2. Applicant is a qualified authorized organization as defined in the Games of Chance Licensing Law.
3. All the members designated in the application to conduct games are bona fide active members of the applicant
organization.
4. The premises presently owned or occupied by the applicant are in every respect adequate and suitable for
conducting games of chance.
5. The games of chance are to be conducted in accordance with the provisions of the Games of Chance Licensing
Law, the Rules and Regulations of the N.Y.S. Racing and Wagering Board, and local ordinances.
6. The entire net proceeds are to be devoted exclusively to one ore more of the "lawful purposes" as defined in the
Games of Chance Licensing Law and the Rules and Regulations of the N.Y.S. Racing and Wagering Board.
7. There is satisfactory proof that no commission, salary, compensation, reward or recompense will be paid or
given to any person for conducting the games or assisting therein, except to the extent authorized by the Games
of Chance Licensing Law and the Rules and Regulations of the N.Y.S. Racing and Wagering Board.
8. There is satisfactory proof that the type and value of prizes offered and given will be in accordance with the
provisions of the Games of Chance Licensing Law.
9. If applicable, the rent Lo be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
DYes DNo
DYes DNo
DYes DNo
DYes DNo
DYes DNo
DYes DNo
DYes DNo
DYes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED D; license is DENIED D
Signature of
Filing daLe of Application Authorized Officer
Date
Title
(Municipal Licensing Authority)
ONE COPY OF THIS FORM TOGETHER WITH ONE COPY OF FORM GC-2, 2A, 2B MUST BE RECEIVED BY THE
N.Y.S. RACING AND WAGERING BOARD FIVE DAYS PRIOR TO THE FIRST AUTHORIZED LICENSE PERIOD.
L BJ.GC-4 (Rev. 4/03) 11111111111111111111I1111I111 ~