Wappinger Elks Lodge (2)
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDlEBUSH ROAD
WAPPINGERS FAllS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOlONI
ROBERT l. VAlDATI
December 8, 2005
Dutchess County Commissioner of Finance
22 Market Street
Poughkeepsie, New York 12601
Subject:
ADD'L. LICENSE FEE - GAMES OF CHANCE
Enclosed is a check in the amount of $39.00 made payable to the D. C. Finance
Commissioner from the Wappinger Elks Lodge #2609, Town of Wappinger, for an
"additional license fee" for Games of Chance activity that took place on 10/07/2005. -
John C. Masterson
Town Clerk
Town of Wappinger
smk
50-235552
WAPPINGERS LODGE #2609 BPOE OF THE USA INC. 219
P.O. BOX 47 6801484113
WAPPINGERS FALLS, NY 12590 DATE ///2/ At .5'
112
~
~ ~~bJ~6::EtA1~ ~~$39, ,m
~ - &~.
~4 ~ · /;f7'Z -- . . DOLLARS ~ ~::;:::::::"
THE
BANKOF
NE\\T 48 Vassar Road ~
YORK Poughke,p';', NY 12603 ...---. #l"'~" .
MEMO~A<;V~,-~ ____ J~i.-~__.____.!!!.
I: 0 2 . gO 2 :) 5 21: III b B 0 . '-t B '-t . . :)111 0.. 2
i
r
GC-7
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
INSTRUCTIONS: Prepare report in triplicate. Within 7 days after each license period, send original to clerk of municipality, send one copy to
N.Y.S. Racing & Wagering Board, Bureau of Bell Jar & Charirable Gaming Compliance, 1 Watervliet Ave. Ext., Suite 2. Albany, NY 12206-1668,
and retain one copy for your files. Where applicable, one copy shall also be submitted to the Chief Fiscal Officer of the County.
-,
FINANCIAL STATEMENT
OF GAMES OF CHANCE
OPERATIONS
(Please Print or Type)
fAlA I; 1)l6EIl f"fi l{J PS90
Zip
~{/ 7C/Jf~S
County
Number of Players
A. RECEIPTS-
1. Admissions (if fee is charged). ................................................ ..... .......................
2. Profit or Loss from games other than Merchandise Wheels................................
3. Profit or Loss from Merchandise Wheels............................................................
(Form GC-7B must be completed and attached)
Number of Types of Games
Zip County
3 [2]Q] / [ill] / ~ t
Date of License Period Hours of License Period
Street Address
4. Total Receipts (Add Items 1,2 and 3)................................................................
B. EXPENDITURES - (Show only payments actually made)
Describe Expenditure Payee
$
$
$
$
$
$
6 . Total Expenditures............. ........ ............... ................... .................. ........ .............. $
C. NET PROFIT OR (LOSS) $
I. Profit or (Loss) Before Additional License Fee (Item A4 less Item B6)...............
2. Additional License Fee (llST CHECK NUMBER II J.. )..................... $
3. Net Profit or (Loss) (Item 1 less Item 2)............................................................... $
D. GAME BANK FUND Payee Check No. Amount
(Memo Entry Only)
E. DISPOSmON OF AND ACCOUNTING FOR NET PROCEEDS -
1. If this is organization's first license period, give opening balance, if any, in the $
Special Games of Chance Account........................................... ............................
Source of opening balance $
2. Unexpended balance of net proceeds shown on last report..................................
L BJ-GC.7 (Rev. 4/03) Page 1 of 2
Check No.
. IT]
c2 r? .10 10 I
. IT]
LJ S' .~
3 t, .m
. IT]
L, . [ill]
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. [ill]
I.~
1. Rent
2. License Fee f!Jt 1, he q ulJl.1I TIJ JolP
3. Games of Chance Equipment
and Supplies
4. Services C LEA)}I Jl " t. R€IT&("plL
5. Other Expenses IJat LlcfHS [ f. Ik4't./IJJJ,7/J /07
- .8:]
" . [1Ig]
111111111I1111111111111111 ~
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. [QJQJ
o .@]Q]
o .m
-1 .17 I :LI
Amount
7. Total Disbursements............................................................................................ $ IT'I"~ .0QJ
8. Unexpended balance of net proceeds (Item 6 less Item 7)................................... $ ~. ~
(Include interest bearing accounts)
F. Reconciliation of Unexpended Balance (To be Completed Monthly - - Upon receipt of Monthly Bank Statement)
Depository Name of Bank _ . Account No. . ~COnCiled ~alance
1) Checking IJ/Hl t oP ).1,/- b 80 I'IB '111'3 _ 7"7, 7.2-
2) Savings
3) Other
Total (Must be the same as Line E8 - Unexpended Balance)............................... $
InstnIctions: This section must be fully completed by all parties.
I swear, or affirm tbat the information and statements contained herein have been examined by me and to the best of my
knowledge and belief are tme, correct and complete.
First Name Last Name
PJ.Ij/j i.J7 7B:2.t'l-iPJriS/. Sq:T€ h~hK.ILl 1'.5;;'-/
7rillm ) [f]m:J - ~3l1Jj W. L M l'
Phone Number ~re
Mem~rinChar~: .
OU}.s j}f/TO
First Name: (} Last Name
~q JrcbJrlS'f'JtJ l~}J€ WAPfJ}i6(1! /1Jzu /.2SC)O
Street Address City /l ~p
( [lliE] ) ~ - [1l!IillJ JJ<>>.AJ~lU
Phone Number Signature
Pre arer (if different):
ot3ER.
/6 lJOtfJ cIt.fiiJ /JR.. [)J/JfJIJ
Street Address City
( CffiE] ) [fIill] - ~
Phone Number
L JlJ-GC.7 (Rev. 4103)
/J ()'K:hFSS
County
OJ/OJ/m
Date
f){)Tch!~~
County
[ill] / [2EJ / [QI]
Date
Page 2 of2
iJo7CJ;rs5
County
CZILJ/~/loI5'1
Date
111111111111111111111111 ..J
r
GC- 7B
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
CASH CONTROL REPORT
GAMES OF CHANCE
t'
Organization:
I.D.No.:
Date of License Period:[]] I []] I []]
. ---. .,," ..'---"""-"-'.- ,,-
Type of Game Type of Game Type of ~e Type of Game Type of Game CONTROL SUMMARY
No. 1 /!Jhck.:J/lck. No. 2.JOt:.IiJl Pcf:./flt. No.3 I'/. SIt No.4 No.5 PROFIT OR (LOSS)
Number of Number of Number Of-i- Number of Number of (A) - Ii 77? (/0
Locations g>. Locations / Locations Locations Locations Game No. 1
Starting Starting Starting Starting Starting (B) - /0 ).00
Game No.2
Bank. 500,0t' Bank /oo.()O Bank Bank. Bank
---~------ (C) -
Ending Ending Ending Ending Ending Game No.3 .. cJ '
Bank I,Z 7Q. 00 Bank ;1-67.00 Bank Bank. Bank.
(D) -
Profit or 7 7 q Profit or Profit or Profit or Profit or Game No.4 -0-
(Loss) ,00 (Loss) 107.00 I (Loss) (Loss) (Loss) (E)-
(A) (B) (C) (D) (E) Game No.5 -D-
ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
WORKERS WORKERS WORKERS WORKERS I WORKERS
l$l€ it 57 ') I Net Profit 1188t.oo
Anf}c l!A or (Loss)
or (Enter on Line A-2 of GC-7)
. ---.-..--.-..-.-----
fJoiFliT AC<fU/}/'IiT71
L BJ.GC.7B (Rev. 4/03)
Page lof2
Prepared By
11111111111111111111111111111 .J
Schedule 4. Assistants to Members in Charge of Games
First MI
Frank
Philip A.
Ralph J.
Henry J.
Harold A.
Francis J.
Roger
Richard O.
Richard D.
Stephen F.
Robert
Mark H.
Harris C.
Robert J.
Joseph
William K.
Eugene P.
Rosemarie
Gregory F.
Kenneth J.
Robert N.
Last Name
Abato
Abbate
Anzivina
Boldrin
Crawford Sr.
DeGano
DeJordy
Desruisseau
Dobbins
Drobnak
Fischetti
Fox
Jones
Ju1iano
Jurina
Minkowski PSVP
Pampalone
Perretta
Sarno
Tucker
Wallner
DaB Address
04/24/1940 39 Kensington Drive
05/16/1937 6 Hackensack Hghts Rd
12/21/1935 12 Thoms Lane
01/11/1936 28 Gold Road
02123/1936 318 Sunset Hill East
07/18/1946 27 Brandy Lane
09/19/1944 83 Kent Road
11/05/1936 183 Red Cardinal Court
05/30/1949 6 Schuele Drive
02102/1957 53 Moccasin View Rd.
06/07/1926 91 Ardmore Drive
09/15/1957 28 Tiger Road
04/24/1944 217 Brothers Road
10105/1953 2776 West Main Street
02/28/1963 173 Hillside Lake Rd.
03/20/1942 427 McGrath Blvd.
09/03/1936 53 Helen Drive
09/07/1943 35 Cathy Road
07/01/1936 13 Dana Place
03/1912029 34 Pawling Lake
01/17/1933 7 Kinry Road
Town
Hopewell Jct
Wappingers Falls
Highland
Wappinger Falls
Fishkill
Wappingers Falls
Wappingers Falls
poughkeepsie
Wappingers Falls
Fishkill
Wappingers Falls
Hopewell Jct.
Stormville
wappingers falls
Wappinger Falls
Fishkill
Wappingers Falls
poughkeepsie
Wappingers Falls
Pawling
poughkeepsie
Yrs an Elk
8
15
18
12
15
15
15
18
19
6
25
11
15
10
7
25
17
5
25
6
16
r MERCHANDISE WHEELS
Merchandise Wheel No. 1 Merchandise Wheel No.5 Merchandise Wheel No.9
Receipts (Less change bank) Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded --- Less: Value of Mdse. Awarded
Profit or (Loss) (A) Profit or (Loss) (E) Profit or (Loss) (1)
Merchandise Wheel No.2 Merchandise Wheel No.6 Merchandise Wheel No. 10
Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
Profit or (Loss) (B) Profit or (Loss) (F) (1)
Merchandise Wheel No.3 Merchandise Wheel No.7 Merchandise Wheel No. 11
Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
Profit or (Loss) (C) (G) Profit or (Loss) (K)
Merchandise Wheel No.4 Merchandise Wheel No. 12
Receipts (Less change bank) Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
-,.
(A) - Mdse.
Wheel No.
(B) - e.
W I No.2
) - Mdse.
Wheel No.3
(D) - Mdse.
Wheel No.4
(E) - Mdse.
Wheel No.5
(F) - Mdse.
Wheel No.6
(G) - Mdse.
Wheel No.7
(H) - Mdse.
Wheel No.8
(1) - Mdse.
Wheel No.9
(J) - Mdse.
Wheel No. 10
(K) - Mdse.
Wheel No. 11
(L) - Mdse.
Wheel No. 12
Net Profit
or (Loss)
(Enter on Line A-3 of GC-7)
Profit or (Loss) Profit or (Loss)
~ ~ ~
OFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
Page 2 of 2
\1\\\ D \11111111\\111111111 ..J
,
-,
r
GC-7
NYS RACING & WAGERING BOARD
I Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.oy.us
INSTRUCTIONS: Prepare report in triplicate. Within 7 days after each license period, send original to clerk of municipality, send one copy to
N.Y.S. Racing & Wagering Board, Bureau of Bell Jar & Charitable Gaming Compliance, ] Watervliet Ave. Ext., Suite 2, Albany, NY ]2206-1668.
and retain one copy for your files. Where applicable, one copy shall also be submitted to the Chief Fiscal Officer of the County.
FlNANCIALSTATEMrnNT
OF GAMES OF CHANCE
OPERATIONS
(Please Print or Type)
wAfJ fJi}l6EJ.. /":Allj J)s9o
Zip
~(/ 7C/;E~S
County
Street Address
Zip County
3 [2]Q] / [ill] / ~ t
Date of License Period Hours of License Period
Number of Players
A RECEIPTS-
1. Admissions (if fee is charge{
2. Profit or Loss from games ot
3. Profit or Loss from Merchar
(Form GC-7B must be comr
4. Total Receipts (Add Items I
B. EXPENDITURES - (Show only
Describe Ex]
r-
'\~
\
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._.\.., C~_....J
. '. ..,._.,.~,.....w----...
...J-{ A. . .
t -1 - CJ
/
I L:J
1011 \ 0
LJ 5
3 ~
I () {p
7 ->3 ()
3 ~
6. Total Expenditures......... ..... ............................. ..... ........... ........... ............. ............ $
C. NET PROFIT OR (LOSS) $
1. Profit or (Loss) Before Additional License Fee (Item A4 less Item B6)...............
2. Additional License Fee (UST CHECK NUMBER / / .2. )..................... $
3. Net Profit or (Loss) (Item 1 less Item 2)............................................................... $
D. GAME BANK FUND Payee Check No. Amount
(Memo Entry Only)
E. DISPOSmON OF AND ACCOUNTING FOR NET PROCEEDS -
1. lfthis is organization's first license period. give opening balance, if any. in the $
Special GaIIleS of Chance Account.......................................................................
Source of opening balance $
2. Unexpended balance of net proceeds shown on last report..................................
L BJ-Ge-7 (Rev. 4103) Page lof2
.OJ
;l. 3'" . [Q]Q]
.OJ
.~
.m
.OJ
. [ill]
. [ill]
. [ill]
I .@]Q]
1. Rent
2. License Fee
3. Games of Chance Equipme
and Supplies
4. Services C iEIJ}JJ JJ "
5. Other Expenses &.tt LIe
- .m
" .eM
11111111111111111111111111 -1
3. Net pro:fit or (Loss) from this license period (part C, Item 3).............................. $
4. Interest earned on net proceeds on deposit in interest bearing account(s)............ $
5. Other deposits into or adjustments in Special Games of Chance Account............ $
Explanation
6. Total net proceeds (add Items 1 through 5)..............................................,........... $
Disbursements of net proceeds since last report: (Attach additional sheets if necessary)
Date Check No. Description of Disbursements Name & Address of Pavee
--,
. [ili]
o . @]Q]
o .m
"i
r
-1 .1712.1
Amount
7. Total Disbursements............................................................................................ $~. ~
8. Unexpended balance of net proceeds (Item 6 less Item 7)................................... $ ~. [2:g]
(Include interest bearing accounts)
F. Reconciliation of Unexpended Balance (To be Completed Monthly - - Upon receipt of Monthly Bank Statement)
Depositorv Name of Bank .. Account No. iconciled ~alance
1) Checkillg B/J.~t oP ).1-/, (pSa 1'/8 '111'3 ~ 107. 7.z.
2) Savings
3) Other
Total (Must be the same as Line E8 - Unexpended Balance)............................... $
InstnIctions: This section must be fully completed by all parties.
I swear, or affirm that the information and statements contained herein have been examined by me and to the best of my
knowledge and belief are true, correct and complete.
/J j)K:~Es.>
County
m I m 1m
Date
. WAPf}JJ6{A. fj,lU 1.2 SC) 0
Zi
J~~lu
Signature
/JIJ Ie),!;';
County
UI2J I [2G I rn
Date
L BJ-GC-7 (Rev. 4103)
Page 2 of2
!Jo'lChrJ5
County
WLJ/[Z0/~
Date
111111111111111111111111 ..J
r
GC- 7B
NYS RACING & WAGERING BOARD
I Watervliet Ave. Ext., Suite 2
Albany. NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.rdcing.state.ny.us
CASH CONTROL REPORT
GAMES OF CHANCE
-,
Organization:
I.D. No.:
Date of License Period:CD I CD I CD
.....-.-....
Type of Game Type of Game Type of ~e Type of Game Type of Game CONTROL SUMMARY
No. 1 NhcR^cK:. No. 2.JO~1i~ /M:.lfll. No.3 1'1- 51X No.4 No.5 PROFIT OR (LOSS)
Number of Number of Number Of-i- Number of Number of (A) - Ii 777. (,IV
Locations ~ Locations I Locations Locations Locations Game No. 1
Starting Starting Starting Starting (B) - /07.00
Starting Game No.2
Bank S'Oo,O() Bank 100.00 Bank Bank Bank
---------- (C) -
Ending Ending Ending Ending Ending Game No.3 ., 0-
Bank 1,:l.7Cf.oo Bank ;'67.00 Bank Bank Bank (D) -
Profit or '1 Profit or Profit or Profit or Profit or Game No.4 -0-
(Loss) 77 .00 (Loss) /tJ7.()O 1 (Loss) (Loss) (Loss) (E)-
(A) (B) (C) (D) (E) Game No.5 -0-
ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
WORKERS WORKERS WORKERS WORKERS WORKERS
l SlE Net Profit 1/88t.. 00
)[,A it 57 \ or (Loss)
AllfJc
(Enter on Line A-2 of GC-7)
__..__...._u___
fJuiEf!T AeCf ul}/'IITl1
L BJ.GC.7B (Rev. 4103)
Page 1 of2
Prepared By
11111111111111111111111111111 .J
Schedule 4. Assistants to Members in Charge of Games
First MI
Frank
Philip A.
Ralph J.
Henry J.
Harold A.
Francis J.
Roger
Richard O.
Richard D.
Stephen F.
Robert
Mark H.
Harris C.
Robert J.
Joseph
William K.
Eugene P.
Rosemarie
Gregory F.
Kenneth J.
Robert N.
Last Name
Abato
Abbate
Anzivina
Boldrin
Crawford Sr.
DeGano
DeJordy
Desruisseau
Dobbins
Drobnak
Fischetti
Fox
Jones
Ju1iano
Jurina
Minkowski PSVP
Pampalone
Perretta
Sarno
Tucker
Wallner
DaB Address
04/24/1940 39 Kensington Drive
05/16/1937 6 Hackensack Hghts Rd
12/21/1935 12 Thoms Lane
01/11/1936 28 Gold Road
02123/1936 318 Sunset Hill East
07/18/1946 27 Brandy Lane
09/19/1944 83 Kent Road
11/05/1936 183 Red Cardinal Court
05/30/1949 6 Schuele Drive
02102/1957 53 Moccasin View Rd.
06/07/1926 91 Ardmore Drive
09/15/1957 28 Tiger Road
04/24/1944 217 Brothers Road
10/05/1953 2776 West Main Street
02128/1963 173 Hillside Lake Rd.
03/20/1942 427 McGrath Blvd.
09/03/1936 53 Helen Drive
09/07/1943 35 Cathy Road
07/01/1936 13 Dana Place
03/1912029 34 Pawling Lake
01/17/1933 7 Kinry Road
Town
Hopewell Jct
Wappingers Falls
Highland
Wappinger Falls
Fishkill
Wappingers Falls
Wappingers Falls
poughkeepsie
Wappingers Falls
Fishkill
Wappingers Falls
Hopewell Jct.
Stormville
wappingers falls
Wappinger Falls
Fishkill
Wappingers Falls
poughkeepsie
Wappingers Falls
Pawling
poughkeepsie
Yrs an Elk
8
15
18
12
15
15
15
18
19
6
25
11
15
10
7
25
17
5
25
6
16
r MERCHANDISE WHEELS
Merchandise Wheel No. 1 Merchandise Wheel No.5 Merchandise Wheel No.9
Receipts (Less change bank) Receipts (Less change bank.) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded--- Less: Value of Mdse. Awarded
Profit or (Loss) (A) Profit or (Loss) (E) Profit or (Loss) (I)
Merchandise Wheel No.2 Merchandise Wheel No.6 Merchandise Wheel No. 10
Receipts (Less change bank.) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
Profit or (Loss) (B) Profit or (Loss) (F) (J)
Merchandise Wheel No.3 Merchandise Wheel No.7 Merchandise Wheel No. 11
Receipts (Less change bank) Receipts (Less change bank.)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
Profit or (Loss) (C) (G) Profit or (Loss) (K)
Merchandise Wheel No.4 Merchandise Wheel No. 12
Receipts (Less change bank.) Receipts (Less change bank.) Receipts (Less change bank.)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
I
(A) - Mdse.
Wheel No.
(B) - e.
WINo. 2
) - Mdse.
Wheel No.3
(D) - Mdse.
Wheel No.4
(E) - Mdse.
Wheel No.5
(F) - Mdse.
Wheel No.6
(G) - Mdse.
Wheel No.7
(H) - Mdse.
Wheel No.8
(I) - Mdse.
Wheel No.9
(J) - Mdse.
Wheel No. 10
(K) - Mdse.
Wheel No. 11
(L) - Mdse.
Wheel No. 12
. j
Net Profit
or (Loss)
(Enter on Line A-3 of GC-7)
Profit or (Loss) Profit or (Loss)
~ ~ ~
OFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
Page 2 of 2
1111111\111111111111111111 .J
I
GC-S
-,
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
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE 01
BELL JAR 0
RAFFLE 0
GC-~-~-[ililiJ- ~
N.Y.S. Identification Number
This License Must Be
Conspicuously Displayed
During Conduct of Games
Municipal License Number
The following organization:
$1 75.00 II I
Amount of Fee Paid Lessor's License Number
Address: 1195 Route 376 City: Wappingers Falls Zip Code: 12590
Entire net proceeds to be devoted to the following specific lawful purpose(s):
1/3 To Be Used for Charitable Purposes 2/3 For Operation of Fraternal Org-anization
Names of Members in Charge
Louis Antolotti
Simon Kaufman
Paul U. Bader III
James R. Boyer, Jr.
LICENSE PERIOD
DATE DAY OF WEEK
10/07/05
11/04/05
12/02/05
RAFFLE DRAWING
DATE
Friday
Friday
Friday
DRAWING TIME
HOURS
7:00pm - 01:00am
7:00pm - 01:00am
7:00pm - 01:00am
TYPE(S) OF GAMES
Black Jack (3 occas.)
Joker Poker (3 occas.)
Big- Six
(3 occas.)
DRAWING LOCATION
AMOUNT OF RAFFLE PRIZES (Cas~ or Merchandise Prizes
at Falf Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
Three $ 100.00
NUMBER OF GAMES EACH GAME (Starting Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
EACH WHEEL
NUMBER OF WHEELS
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
STATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
Issued by TOWN OF WAPPINGER
(Name of Municipality)
~~~
L BJ.GC-5 (Rev. 4/03)
TOWN CLERK
(Title of Authorized Officer)
. 0
(Si ature of Authorized Officer)
11111111111111111111111111111 ~
r
GC-4
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
--,
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC- [illJ- 02JIJ - ~ - ~
N.Y.S. Identification Number .
fL; t.tY AI ~I tJA-1 fj /ilG E ~
Name of Municipality
"
/1 f 5 L--I-i,g7 (.
Address
IJ ft fJll / #t:.L:~.s /A J!.L. ~
./
Alc-l 1~5?~
I
Law, the following findings and detenninations
~s DNo
1. All the members-in-charge designated in the ap
character and have never been convicted of cri
Signature of Person Conducting Investigati
//
~\tt
2. Applicant is a qualified authorized organizati n 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 ChanceL1censingLaw -and.1he.Rules aild 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 to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
llf Yes DNa
r!I Yes DNo
lZfYes DNo
ri' Yes DNo
Ii' Yes DNo
rn Yes DNa
[!] Yes DNa
Rl Yes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED f(!; licens
~ I .' / _ Signature of
Filing date of Application fI/S;/ CJ!J Authorized Officer
'censing Authority)
Date fp~/lJ5 . Title' Town Clerk
ONE COPY OF TIllS FORM TOGETHER "'WITH ONE COpy OF FORM GC-2, 2A, 2B MUST BE RECEIVED BY THE
N.Y.S.RACINGAND WAGERING BOARD FIVE DAYS PRIOR TO THE FIRST AUTHORIZED LICENSE PERIOD.
L BJ-GC-4 ntev.4/03) -1111111]111111111111111111111 ~
I
GC-S
I
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE ~
BELL JAR 0
RAFFLE 0
GC-Iill-~-~-~
N.Y.S. Identification Number
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
This License Must Be
Conspicuously Displayed
During Conduct of Games
$1 75.00 II I
Amount of Fee Paid Lessor's License Number
Address: 1195 Route 376 City: Wappingers Falls Zip Code: 12590
Entire net proceeds to be devoted to the following specific lawful purpose(s):
1/3 To Be U sed for Charitable Purposes 2/3 For Operation of Fraternal Org'anization
Names of Members in Charge
Louis Antolotti
Simon Kaufman
Paul U. Bader III
James R. Boyer,
LICENSE PERIOD
DATE
10/07/05
11/04/05
12/02/05
RAFFLE DRAWING
DATE
Jr.
DAY OF WEEK
Friday
Friday
Friday
HOURS
7:00pm - 01:00am
7:00pm - 01:00am
7:00pm - 01:00am
TYPE(S) OF GAMES
Black Jack
Joker Poker
(3 occas.)
(3 occas.)
(3 occas.)
Big' Six
DRAWING TIME
DRAWING LOCATION
AMOUNT OF RAFFLE PRIZES (Cas~ or Merchandise Prizes
at Fan Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
Three $ 100.00
NUMBER OF GAMES EACH GAME (Starting Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
EACH WHEEL
NUMBER OF WHEELS
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
STATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
Issued by TOWN OF WAPPINGER
(Name of Municipality)
~~~~
L BJ.GC-5 (Rev. 4/03)
TOWN CLERK
(Title of Authorized Officer)
. 0
(Sic> ature of Authorized Officer)
11111111111111111111111111111 ..J
r
GC-2
-,
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
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE}(
BELL JAR 0
RAFFLE 0
FOR OFFICE
USE ONLY
$1 75,(} lJ
Fees Received
[Q]fJ / ~ / [ill]
Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC- [2li]- [4U]jJ- ~- ~
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
Tit.) Ii 01 Wfit'ljJGI!. 11, 7C~i~S
Name of Municipality County
2. Address
3. Has applicant ever been denied a games of chance license? 0 Yes 0 No
4. Check type of organization and, if applicable, give the State and date of incorporation.
Corporation 0
lId State incorporated IJ$W "0 ek.
Incorporated Association r' I '
Unincorporated Association 0
State incorporated
Date ~ / [QIl] / ~
DateDJ/DJ/DJ
Individual
o
5. Did your corporate status change since your identification number was assigned? 0 Yes ~'No
6. Are you doing business under a trade name? 0 Yes JS1 No If "yes", what is the trade name?
PART B. LOCATION OF GAMES
7. Address where games, bell jar. or raffle drawing(s) are to be conducted. 1/95' il. 37(,;
8. Name and address of authorized games of iJJ~
chance lessor renting to applicant. '/),
WhPIIJJ6U hi Ll.J.I". 'J,
.
9. Does the applicant own the premises? "g{ Y es 0 No If "yes". how long?
/1 fl/,l)~
r);l(, I~AS#~
11. Have premises been regularly used? )1'Yes 0 No If "yes", how long? } ~
Are games of chance being played now on these premises or has it ever been? ~Y es
J.ftsT 'GA-Hls OF cll/tIJt-l'" ()tJ ~~, JDJ
, I
12. Are the premises or any part thereof If "yes", state the type of license and number.
where games of chance are to be played 1B Yes 0 No L 7C/ - 02' J j
licensed by the State Liquor Authority? C - 000 "'{..J
1 O. Capacity for public assembly of premises presently owned or occupied.
Y'A~
o No If "yes", give full details.
13. Has such license ever been 0
revoked or suspended? Yes
)11 No
If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
L BJ-GC-2 (Rev. 4103)
Page 1 of2
IIIIIIII~IIIIIIIIIIII ~
r
I
PART C. PURPOSES OF GAMES
14. State th specific purposes for which the entire net proceeds are to be devoted and in what manner.
I 70 IJ€ (J5J'1) lOll cHI1,R171J~J..1 fJtll2fJ()$E~
foJ!. oJiA.,IJ 7J,}i F ,c/J1J 'll'.LJlA l ol2tJ4-)J J~A 7J1J#
I swear (or affirm):
]. That ALL the attached Schedules are a material part hereof and are incorporated herein as if set out in full in the application. All the answers
contained in this application are a material part hereof.
2. That the entire net proceeds of all games of chance shall be devoted exclusively to one or more of the "lawful purposes" as defined in the Games of
Chance Licensing Law and the Rules and Regulations of the Board.
3. That for each license period for which a license is sought, one or more of the active members under whose supervision the games are to be held,
openll.ed and conducted, who is familiar with the Games of Chance Licensing Law, the Rules and Regulations of the N.Y.S. Racing & Wagering
Board and local licensing ordinances or Jaws, will be present at all times, in charge and primarily responsible for the conduct of games.
4. That the undersigned will be responsible for the holding, operation and conduct of all games of chance in accordance with the terms of the license,
the provisions of the Games of Chance Licensing Law, the Rules and Regulations of the N.Y.S. Racing & Wagering Board and with the provisions
of local licensing ordinances or laws.
5. That the undersigned has read and is familiar with the provisions of the Games of Chance Licensing Law as amended, the Rules and Regulations
of the N.Y.S. Racing & Wagering Board, and the local licensing ordinances or laws.
6. That no commission, salary, compensation, reward or recompense will be paid to any person for holding or assisting in the operating or
conducting of the games, except to bookkeepers or accountants for professional services in an amount not exceeding that fixed by the Board.
[QJ1] / 1/ Isl / [ill]
Date
.57fI/l1/J JJiotllIJL
Print Name
STATE
OF
NEW YORK
}ss
CITYffOWNNILLAGE
COUNTY
OF
S
that (s)h has read the foregoing statement and the answer therein noted, and that such answers are true and that (s)he has personally
affixed his (her) signature to this affidavit.
Sworn to before me this
/ ~ day of84J~
, 20 D,S'
s;~~~~
Commissioner of Deeds
Notary Public
10/30
I
, 20..!Lh
r'~:";l.ai:
UtW-:iCK M:_LS
,'l, ",,::c f'f New 'l'\lll<
I ( ',~< 1.
'r. :" ".;ii,;'~;, COI.IIIJ,l., I
~~:'~: 'f~' 311~
My Commission expires
i.J
Ci)C ,;\ \\~:~~
L BJ,-GC.2 (Rev, 4103)
Page 2 of2
11..1 -.J
'~
r
GC-2A
-,
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
APPLICA TION FOR GAMES OF CHANCE LICENSE
GC- [IE] - 01liJ - [llig] - ~
NYS Identification Number
1
[ili]/[ill/~
Date
SCHEDULE 1:
OFFICERS AND DIRECTORS
List names, addresses and dates of birth of all officers.
If organization is a corporation, or an incorporated or unincorporated association, list officers and directors.
( TITLE N~E DATE OF BIRTII STREET ADDRESS
!iljl AlF~IIE/) 1..1.57 I_I _I_I
I 1_/_1_1
1 1_/_1_1
1 1_1_1_'
1 1_/_1_1
I /_/_1_1
I 1_/_1_1
1 1_/_1_1
1 1_/_1_1
1 1_/_1_1
1 1_/_1_1
Attach additional sheet if necessary.
CITY
ZIP
SCHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF
NAME }, ~OF BIRTH MEMBERSHIP. STREET ADDRES. S
(5'11' 1J/iIJC)lb; I~I _I _I I
1_/_1_1 1
1_/_1_1 1
1_/_1_1 1
1_/_1_1 1
1_/_1_1 1
1_/_1_1 1
1_/_1_1 I
1_/_1_1 I
CITY
ZIP
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF2 AUXn.JARIES/AFFILIATES. EACH AUXn.JARY/AFFILIATE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME O~rY/AFFlllATE
GAMES OF CHANCE ID NUMBER
IIIIIIIUII~IIII .J
L BJ-GC-2A (Rev. 4103)
Page I of2
r SCHEDULE 7 TYPES OF GAMES -,
List all of the single types of games to be conducted at all license periods enumerated in Schedule 5.
Note for Ve28S Ni2hts and Bazaars onlv: The total amount of prizes during anyone license period shall not
aggregate more than $400 for each single type of game of chance when five types of games of chance are to be
conducted during anyone license period. The total amount of prizes during anyone license period shall not
aggregate more than $500 for each single type of games of chance when less than five single types of games of
chance are to be conducted during anyone license period.
LIST NAME OF EACH TYPE OF
GAME OF CHANCE
(Limit: 5 Games)
j IAck::rAt! K.
:rok~ Po/U.e
(j/~ SIX
LIST THE MAXIMUM AMOUNT OF PRIZES
TO BE AWARDED FOR EACH TYPE OF
GAME OF CHANCE (GAME BANK)
at $ SCO.oO
at $ 100.00
at $ !O().OO
at $
at $
For Merchandise Wheels, Bell Jars and Raffles, please complete the appropriate spaces below.
MERCHANDISE WHEELS:
INDICATE NUMBER OF
MERCHANDISE WHEELS
(NO LIMIT)
ilM
f
THE TOTAL AMOUNT OF PRIZES FOR
EACH MERCHANDISE WHEEL SHALL
NOT EXCEED $10,000 AND NO SINGLE
PRIZE SHALL EXCEED $250
BELL JAR:
INDICATE IF THIS APPUCATION
IS FOR A BELL JAR
UCENSE
YESD N01
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BELL JAR DEAL SHALL NOT
EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500
RAFFLES:
INDICATE IF THIS APPUCATlON
IS FOR A RAFFLE
LICENSE
YESD NO;g
IF YES, LIST RAFFLE DATES, TIME(S)
OF DRA WING(S) AND PRIZES IN
SCHEDULE 5
THE TOTAL AMOUNT OF PRIZES FOR
ALL THE RAFFLES CONDUCI'ED DUR-
ING THIS CALENDAR YEAR SHALL
NOT EXCEED $100,000. NO SINGLE
PRIZE SHALL EXCEED $50,000
EXCEPT THAT A SINGLE PRIZE OF
$100,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L BJ-GC-2B (Rev.4J03)
Page 2 of2
11111111111111111 -1
Schedule 4. Assistants to Members in Charge of Games
First MI
Frank
Philip A.
Ralph J.
Henry J.
Harold A.
Francis J.
Roger
Richard O.
Richard D.
Stephen F.
Robert
Mark H.
Harris C.
Robert J.
Joseph
William K.
Eugene P.
Rosemarie
Gregory F.
Kenneth J.
Robert N.
last Name
Abato
Abbate
Anzivina
Boldrin
Crawford Sr.
DeGano
DeJordy
Desruisseau
Dobbins
Drobnak
Fischetti
Fox
Jones
Juliano .
Jurina
Minkowski PSVP
Pampalone
Perretta
Sarno
Tucker
Wallner
DOB Address
04/24/1940 39 Kensington Drive
05/16/1937 6 Hackensack Hghts Rd
12/21/1935 12 Thorns lane
01/11/1936 28 Gold Road
02/23/1936 318 Sunset Hill East
07/18/1946 27 Brandy lane
09/19/1944 83 Kent Road
11/05/1936 183 Red Cardinal Court
05/30/1949 6 Schuele Drive
02/02/1957 53 Moccasin View Rd.
06/07/1926 91 Ardmore Drive
09/15/1957 28 Tiger Road
04/24/1944 217 Brothers Road
10/05/1953 2776 West Main Street
02/28/1963 173 Hillside lake Rd.
03/20/1942 427 McGrath Blvd.
09/03/1936 53 Helen Drive
09/07/1943 35 Cathy Road
07/01/1936 13 Dana Place
03/19/2029 34 Pawling lake
01/17/1933 7 Kinry Road
Town
Hopewell Jct
Wappingers Falls
Highland
Wappinger Falls
Fishkill
Wappingers Falls
Wappingers Falls
Poughkeepsie
Wappingers Falls
Fishkill
Wappingers Falls
Hopewell Jct.
Stormville
Wappingers Falls
Wappinger Falls
Fishkill
Wappingers Falls
Poughkeepsie
Wappingers Falls
Pawling
Poughkeepsie
Yrs an Elk
8
15
18
12
15
15
15
18
19
6
25
11
15
10
7
25
17
5
25
6
16
r
GC-2B APPLICATION FOR GAMES OF
NYS RACING & WAGERING BOARD CHANCE LICENSE
1 Watervliet Ave. ext.. Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.stale.ny.us
--,
GC- []Ii] - [Wli] - ~ - ~
NYS Identification Number
[ili] / [Z0 / ~
Date
SCHEDULE 5 DATES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPUCABLE FOR BELL JAR GAMES)
HOURS
,1.:.0 ,0 ,ami. - ,0.1 ,:,0,0 ,@/pm 1$.
, 7 . : . 0 ,0 .am p -, 0 . I .:,0 fJ ,@/pm! $ .
, 7.:. 0 . 0 .am p . - . C). I .:. 0 . 0 lip / pm ! $ .
.am/pm - . .am/pm ! $.
,am/pm - , .". .am/pm 1$
,am/pm - , .". ,am/pm!$ ,
am / pm - . " am / pm ! $ .
.am/pm - . ,", .am/pm ! $.
,am/pm - , ,", .am/pm ! $,
,am/pm - .". am/pm! $.
,am/pm - , ,", .am/pm ! $.
,am/pm - . ,', ,am/pm! $.
RENT
.0...0.0.
.0...0.0.
.(').".O .0 .
DATE
. j6.1Q/.O.!f'.!.
li / ~ / , () ,.5.! ,
) .:2 .I , 0 . ~. / . 0 .S' .! ,
/ / !
.I, , / . .! .
. / . . / . I
.I. . / .
. / , ,/ ,
.I. .I.
./ /
, / , ,/ ,
/. .I.
RAFFLES
DATE
. . .
I-'
. .
1-'
.. .
. . .
. . .
. . .
. . .
. . .
1-'
. . .
la.
. . .
am / pm -
. .
am / pm -
. a
am / pm -
. .
am / pm -
. .
am / pm -
. .
SCHEDULE 6 EXPENSES
List items of expense to be incurred, and the names and addresses of persons to be paid.
ITEM OF EXPENSE VENDOR NAME STREET ADDRESS CITY
IJrit2- L Ic.Jj~~~ $ R. 11CC(1J/J/iITIJ It:) Vr>uJlA/L ",~ tJ~/P. /iJ Z~
C~II.I(, K.. ~/rAl)v~1t J.~ !'If/.~}c Leop )/d/rdJt;rC-I.
.J
. J .
. / .
, / .
.J
o/J
I
TIME
. . .
. . .
am / pm
.
am /pm
,
am / pm
,
am / pm
.
am / pm
,
PRIZES (Cash or Fair Market
Value of Merchandise)
$.
$.
'$
.
$
i$
1-.
J
.J
. / .
.J
.J
.. .
. . .
. . . .-
I ,
I
I ,
I
I .
I
. I .
I
. . .
. . .
.. .
.. .
.. .
I ,
. . .
.. .
STATE
/J. y~
AI.y.
ZIP
~9f)
12513
L BJ-GC-2B(Rev.4I03)
Page lof2
glllllll~III~111 -.J
r SCHEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE OF GAMES
Ust all members of applicant organization and members of authorized affiliates and auxiliary who will assist with games. Each person listed must be a
member of applicant OfRlUIizatiOll or affiliate for at least I }'ear.
YEARS OF
MEMBER NAME . J?A~ OF BIRTH MEMBERSHIP STREET ADDRESS
{Sfll 1J1Tj)cflE~~ _/ _ I _ I I
I / / I_I I
'-/-/-1_1 I
1-/-/-'_1 I
1-/-/-1_1 I
'-/-/-1_1 I
1-/-/- _I 1
1-/-/- _I I
'-/-/-1_1 I
1-/-/- _I I
1-/-/- _I I
1-/-/- _I I
1-/-/-1_1 I
1-/-/-1_1 I
1-/-/-1_1 1
1-/-/-1_1 1
'-/-/-1_1 I
'-/-/-1 I 1
1-/-/-'=1 I
1=/=/= I _ I
1_/_/_1_. 1
1 / / ,_ 1
1-/-/-'_1 I
1=/=/=1_1 I
I / / I_I I
1-/-/-1_1 ,
1-/-/-1_1 I
1-/-/-'_1 I
1-/-/-1_1 I
1-/-/-1_' I
1-/-/-1_' 1
1-/-/-1_' I
'-/-/-1_1 I
1-/-/-1_1 ,
---
L BJ-GC-2A (Rev. 4103)
Attach additional sheet if necessary.
Page 2 of 2
I
CITY
ZIP
I
I
I
I
1
I
I
I
I
I
I
I
I
I
I
1
I
I
,
I
I
I
I
I
I
I
I
1
I
,
,
1
I
I
IIIIIIII~IIIIIIIII ..J
\ ~
\
--
",
lt~
.;;..
) -~
~- 'c
,~! (0.;: >
..~
~ ;,~ ;,..4
i. fH~~f t"<"
. l t:~ ,'~'~"~j:~ ~t:~...s::;
Schedule 2. Members in Charge of Games
LAST_NAME FIRST _MI
Antolotti
Kaufman
Bader III
Boyer Jr.
Louis
Simon
Paul U.
James R.
ADDRESS
City Zip DOB Yrs Member
-------------------- ---------- ------------- -------------
Wappingers Falls 12590 06/23/1933 10
Hopewell Jet. 12533 08/16/1930 2
Lagrangeville 12570 09/20/1965 10
Lagrangeville 12570 11/28/1937 22
229 RobinsQn Lane
9 South View Ln.
134 Andrew~ Rd.
134 Andrews Rq.
Schedule 1: Officers and Directors
WAPPINGER LODGE #2609 OFFICERS for 2005-2006
Title Name Address Town Zip DOB
--........--..--...... --....--------- .-.------------------.---- ------------------------------ ------------------------------ ----------, --------------------,
Exalted Ruler Steve Drobnak 53 Moccasin View Rd. Fishkill 12524 02/02/1957
Leading Kgn Pamela Kultsar 58 Hillis Terrace Poughkeepsie 12603 02/01/1950
LoyalKgn Derrick Mills Pawling Lake Box 17 Pawling 12564 10/10/1940
Lect. Kgn Sandra Seekamp 67 Pawling Lake Pawling 12564 12/10/1945
Esquire Mark H. Fox 28 Tiger Road Hopewell Jct. 12533 09/15/1957
Chaplain Diana M. Cole P.O. Box 549 Hughsonville 12537 04/25/1948
Inner Guard Rosemarie Perretta 35 Cathy Road Poughkeepsie 12603 09/07/1943
Secretary Robert M. Acquanita 10 Vorndran Dr. Wappinger Falls 12590 OS/25/1942
Treasurer Richard O. Desruisseau 183 Red Cardinal Court Poughkeepsie 12603 11/05/1936
Tiler Jacqueline Alfano 93 Brothers Rd. Wappinger Falls 12590 08/27/1938
Trustee Patrick J. Moriarty 26 Robert Lane Wappinger Falls 12590 04/16/1941
Trustee Paul U. Bader 366 Andrews Rd. Lagrangeville 12540 09/20/1965
Trustee Harris Jones 102 Brothers Road Stormville 12582 04/24/1944
Trustee Gerhard P. Stoetzel 662 Noxon Road Poughkeepsie 12603 05/02/1942
Trustee Louis Antolotti 229 Robinson Lane Wappinger Falls 12590 06/23/1933
No Officer receives compensation of any kind.
J;o.. ,~
'T',;,Jl.=~-';
~~ '~~~-:
t.-
~
j ,r-
'~:i
';~~
~..
~
~<
',,:::"~ ~'JO'
-,,'~. . " -
",...... '-
"
~
.-.
,1
,
~
','
,...,
~
"
r
GC-4
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
I
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC - I2JI] - 02TIJ - [iliTI] ~ ~
N.Y.S. Identifit:ation Number .
-TeJuYAl ~I /JIJI/lAlGEh
Name of Municipality
"
/lf5 ,t-l-. .57~
Address
lr.J fi fJ fJ /AI 6-e--..e:5 r A ?L. S
",
N(-! / ~S/t;
I
Law, the following fmdings and determinations
After investigation, and a hearing if required under Sec. 192 of the General uni'
have been made:
1. All the members-in-charge designated in the ap . c
character and have never been convicted of eri
Signature of PersDn Conducting Investigati
~s
DNa
e are. of good moral //
~\*
2. Applicant is a qualified authorized organizati nas defined in the Games of Chance Licensing Law.
3. AIl the members designated in the application-to conduct games are bona fide active members of the applicant
organizatiDn.
4. The premises presently owned or occupied by the applicant?Te 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
GamesofCbance:L-icensinj!;Law:<m[l:j:heJ<l11~ .ai1d~~.gulations. of ~~~. 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. to be paid to an authorized games of chance lessor is reasonable.
. .
10. Other findings:.(Specify)
o Yes DNa
EJ Yes DNo
Ii" Yes DNa
ri Yes ONe
Ii' Yes ONe
rn Yes DNo
ii Yes ONe
00 Yes DNo
DYes. DNo
\ .
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and deterniinations stated above, license is GRANTED 1(1; li~ens
~ / . / Signature of
Filing date of Application ~/.l// tJ S Authorized Officer
~~
Date
. Title'
Town Clerk
.censing Authority)
~b~/o5.
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 FJRST AUTHORIZED LICENSE PERIOD.
L nJ-Gc.4 _.4103)11111 mn m Illlm ~ m m ~
r
GC-4
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.lIs
"I
FINDINGS AND
DETERMlNATION
FOR GAMES OF CHANCE
LICENSE
GC-rmJ-01IIJ-~~~
N.Y.S. Identification Number .
-tLJ uJ Ai ~/!J AI /I AlG E /!..;;
Name of Municipality
.l>iI'TCHE55
County
"
Alc-l / ,?S'lO
I
//95 L--I-.J'7t
Address
. f:.) /f fJ f1 / .Al6-L:-~S r A /-.L. :5
",
Law, the following findings and determinations
After investigation, and a hearing if required under Sec. 192 of the General
have been made:
1. All the :members-in-charge designated in the ap
character and have never been convicted of cri
Signature ofPeISDTI Conducting Investigati
e are. of good moral /'/
<:::::::.2-\1.._ rr
.~ 'R-A\\I
2. Applicant is a qualified authorized organizati n as defined in the Games of Chance Licensing Law.
3. All the members designated in the app1icationto conduct games are bona fide active members of the applicant
organization.
4, The premises presently owned or occupied by the applicant?Te 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 "lawfu] purposes" as defined in the
GamesofChancecLicensiPgI..aw,an4,l:11e~~.sand~~oulations of ~.J:'I. 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 anct 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. to be paid to an authorized games of chance lessor is reasonable.
10. Other findings:.(Specify)
~s
DNa
u6 Yes DNo
El Yes DNo
Ii Y es DNa
ri Yes DNa
r:i Yes DNo
I1l Yes DNo
r!i Yes DNa
00 Yes DNo
DYes' DNa
I .
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and deternllnations suited above, license is GRANTED 1(1; licens
~ / . / SignatUre of
Filing date of Application fI/ ~/ () S Authorized Officer
Date 7p~/O 5" . Title' Town Clerk
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< (R~. 4103)lllIm~11 ~ 111lI~ ~ 1II1~1 -.J
I
GC-5
-,
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
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE ~
BELL JAR 0
RAFFLE 0
GC - [ili] - Cil:iliJ- [ililiJ - CililiIiliJ
N.Y.S. Identification Number
This License Must Be
Conspicuously Displayed
During Conduct of Games
$1 75.00 II I
Amount of Fee Paid Lessor's License Number
Address: 1195 Route 376 City: Wappingers Falls Zip Code: 12590
Entire net proceeds to be devoted to the following specific lawful purpose(s):
1/3 To Be Used for Charitable Purposes 2/3 For Operation of Fraternal Organization
Names of Members in Charge
Louis Antolotti
Simon Kaufman
Paul U. Bader III
James R. Boyer, Jr.
UCENSE PERIOD
DATE DAY OF WEEK
10/07/05
11/04/05
12/02/05
RAFFLE DRAWING
DATE
Friday
Friday
Friday
DRAWING TIME
HOURS
7:00pm - 01:00am
7:00pm - 01:00am
7: OOpm - 01: OOam
TYPE(S) OF GAMES
Black Jack (3 occas.)
Joker Poker (3 occas.)
Big Six
(3 occas.)
DRAWING LOCATION
AMOUNT OF RAFFLE PRIZES (Cas~ or Merchandise Prizes
at Fan Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
Three $ 100.00
NUMBER OF GAMES EACH GAME (Starting Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
EACH WHEEL
NUMBER OF WHEELS
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
STATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
Issued by
TOWN OF WAPPINGER
(Name of Municipality)
TOWN CLERK
(Title of Authorized Officer)
(Signature of Authorized Officer)
11111111111 II 1111 111111111111 ..J
(Date)
I
I
\
L BJ.GC-5 (Rev. 4/03)
I
GC-5
I
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
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE ~
BELL JAR 0
RAFFLE 0
GC - [ili] - ~- ~ - CiliIiliIU
N.Y.S. Identification Number
This License Must Be
Conspicuously Displayed
During Conduct of Games
Municipal License Number
The following organization:
$1 75.00 II I
Amount of Fee Paid Lessor's License Number
Address: 1195 Route 376 City: Wappingers Falls
Entire net proceeds to be devoted to the following specific lawful purpose(s):
1/3 To Be Used for Charitable Pur oses 2/3 For 0 eration of Fraternal Or anization
Names of Members in Charge
Louis Antolotti
Zip Code: 12590
Simon Kaufman
Paul U. Bader III
James R. Boyer, Jr.
LICENSE PERIOD
DATE
DAY OF WEEK
HOURS
7:00pm - 01:00am
7:00pm - 01:00am
7:00pm - 01:00am
TYPE(S) OF GAMES
Black Jack
(3 occas.)
10/07/05
11/04/05
12/02/05
RAFFLE DRAWING
DATE
Friday
Friday
Friday
DRAWING TIME
Joker Poker
(3 occas.)
Big' Six
(3 occas.)
DRAWING LOCATION
AMOUNT OF RAFFLE PRIZES (Cas~ or Merchandise Prizes
at FaIT Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
Three $ 100.00
NUMBER OF GAMES EACH GAME (Starting Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
EACH WHEEL
NUMBER OF WHEELS
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
STATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
Issued by
TOWN OF WAPPINGER
(Name of Municipality)
TOWN CLERK
(Title of Authorized Officer)
(Signature of Authorized Officer)
111111111111111I1111111111111 ~
(Date)
L BJ.GC-5 (Rev. 4/03)
r
GC-4
NYSRAaNG&WAGEroNGBOARD
1 Watervlie.1 Ave. Ext, Suite 2
Albany, NY 12206-1668
Telephone (518)453-8460 Fax (518) 453-8492
www.Tacing.state.ny.lIs
I
FINDINGS AND
DETERMINATION
FOR GAMES OF CHA.NCE
LICENSE
GC - [ill] - [illill- ~ - [illill.illJ
N.Y.S. Identification Number ·
-7cJ Lt.') AI ~I !.JA-I /J /J!GE h
Name of Municipality
.1-
/ ~S'lO
//f5 L--f..J7~
Address
. I.U ft fJ fJ / AI ?L:-ft!.S r A ~'" ~
,;'
Alc./
I
Law, the following findings and determinations
/ ~s DNa
1. All the members-in-charge designated in the ap 'c
character and have never been convicted of cri
Signature of Person Conducting Investigati
Title
2. Applicant is a qualified authorized organizati n 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?Te 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 ofChance:L-1censing:I,.aw,.aI14:fue~l?.liand~$lllations of~~~.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 10 the extent authoriZed by the Games
of Chance Licensing Law and the Rilles and Regulations of the N.Y.S. Racing and Wagering Board.
8. There is satisfactOry proof that the type lind 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. to be paid to an authorized games of chance lessor is reasonable.
. .
10. Other findings: .(Specify)
I!f Yes DNa
J!j Yes DNo
0' Yes DNo
Ii Yes DNo
r:i Yes DNo
rn Yes DNo
~Yes DNo
ItJ Yes DNo
DYes DNo
\ . .
TO BE COMPLETED BY MUNIClPAL CLERK:
As a result of the fmdings and deterniinations stated above, license is GRANTED J(\; li~ens
~ / J Signature of
Filing date of Application ~~'f ~I (J S Authorized Officer.
~;e~
'censing Authority)
Date fp~/o5 Title' Town Clerk
ONE COpy OF THIS FORM TOGETHER 'WITH ONE COPY OF FORM GC-2, 2A, 2B MUST BE RECEIVED BY THE
N.Y.8.RACINGAND WAGERING BOARD FIVE DAYS PRIOR TO THEFlRST AUTHORIZED LICENSE PERIOD.
L BJ-GC< (!ill- '1O~)m II 11m m 1II11lm ID ~ ~
ROBERT M. ACQUANITA
ANNA R. ACQUANITA
10 VORNDRAN DR.
WAPPINGERS FALLS. NY 12590-4517
Pay to the -
Order of J /JwN () r
,
S&JGN '7. - F, V It
A HudsonValley
SOiL Federal Credit Union
16118lmegat Rd., POUGHKEEPSIE, NY 12601' 914-t63.3011
For
50-7936/2219
899
Date
rAo /0 s-
/ I
W.A-II/#6€/L
'tC~o Cl ~
I $ 'Zc, 00
------rlollars m~~~L:-
M'
I: 2 2 . g 7 g :U; ~I: 0000000025 bOO gill 0811 g
GUARDIAN@) SAFETY BLUE WD8L
i&lGarireAmerican
ROBERT M. ACQUANITA
ANNA R. ACQUANIT A
10 VORNDRAN DR.
WAPPINGERS FALLS, NY 12590-4517
Pay to the -
Order of J IJw!l 0 r
,
S M6# '7.. - F,v It
A HudsonValley
=.,L Federal Credit Union
159 8am~at Rd., POUGHKEEPSIE, NY 12801 '914-Wl3.3011
For
50-7936/2219
899
Date
7ttJ /0 S-
f I
Lvfr! III'I<</L
)C~o e ~
$ [5. c,o
-----~Bollars m~~~i:'
I M'
- ..._------
I: 2 2.9793 b 31: 00000000 25bOO 9111 08119
GUARDIAN@SAFETY8LUEWOSl
@Clarl<eAmeYiCQIl
r
GC-2
I
NYS RACING & WAGERING BOARD
) Watervliet Ave. Exl., Suite 2
AJbany,NY 122~)668
Telephooe (518) 453-8460 Fax (518)453-8492
www.racing.state.ny.us
APPLICA TION FOR:
PLEASE CHECK
GAMES OF CHANCE 0
BELL JAR 0
RAFFLE 0
FOR OFFICE
USE ONLY
$175, ,,0
Fees Received
[ill] / [I@] / 0I]
Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC - [2]1] - [4]J]i]- ~ - ~
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
'Til,.) II 01 W/JI'I"'~tR.. /1, 7Chl~S
Name of MunicipaJity · County
2. Address
3. Has applicant ever been denied a games of chance license? 0 Yes 0 No
4. Check Iype of organization and, if applicable, give the Slale and dale of incorporation.
Corporation 0
111 Slate incorporated I/fw ""0 ek..
Incorporated Association r' r
Unincorporated Association 0
Slate incorporated
Individual 0
Date ~ / [QI1J / ~
DateITJ / ITJ / ITJ
5. Did your corporate Slatus change since your identification number was assigned? 0 Yes JS'No
6. Are you doing business under a trade name? 0 Yes ~ No If "yes", what is the trade name?
PART B. LOCATION OF GAMES
7. Addresswheregames,belljar,orraftledrawing(s)arctoheconducted.1I9S' ;''1: 37{,,' ~)fiPj)I}J6lL h/LI..f.N,'J.
) .
8. Name and address of authorized games of /J;~
chance lessor renting to applicant. 'II
9. Does the applicant own the premises? ;{Yes 0 No If "yes", how long? 19 YIiA,L.$
J.2 (, I'M'pi'U
11. Have premises been regularly used? ,rYes 0 No If "yes", how long? J ~
Are games of chance being played now on these premises or has it ever been? QJYes
I, I. (;> J ",,,..
J.A.sT GIJ.Hls OF cIIMe-l. o;J o/r:J.t jl''s
, I
12. Arc the premises or any part thereof If "yes", slate the type of license and number.
where games of chance are to be played ~ Yes 0 No L 7<1- 02'J":I
licensed by the State Liquor Authority? C - 000 T...:J
10. Capacity for public assembly of premises presently owned or occupied.
Y4,4~
o No If "yes", give full details.
13. Has such license ever been 0
revoked or suspended? Yes
}tNO
If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
L BJ-GC-Z (Rev. 4193)
Page 1 of2
II~ IIIII1 UIIIIIII 1111 I .-J
r
PART C. PURPOSES OF GAMES
14. State th specific purposes for which the entire net proceeds are to be devoted and in what manner.
j If) t1C USJ'/) ~/l c)//},R171JdJ..f 1II2fJt1SE.$
I()~ ofJl,t,IJ'lJlri ;:;;n 7l'~IIA l ollol?}I /1:)1 lll},.J
-,
I swear (or affirm):
I. That ALL the attached Schedules are a material part hereof and are incorporated herein as if set out in full in the application. All the answers
contained in this application are a material part hereof.
2. That the entire net proa:eds of all games of chance shall be devoted exclusively to one or more of the "lawful purposes" as defined in the Games of
Chance Licensing Law and the Rules and Regulations of the Board.
3. That for each license period for which a license is sought, one or more of the active members under whose supervision the games are to be held,
opt:nlted and conuuClt:d, who is fanliliar with the Games of Chance Licensing Law, the Rules and Regulations of the N. Y.S. Racing & Wagering
Board and Jocallicensing ordinances or laws, will be present al all times, in charge and primarily responsible for the conduct of games.
4. That the undmigned will be responsible for the holding, operation and conduct of all games of chance in accordance with the terms of the license.
the provisions of the Games of Chance Licensing Law, the Rules and Regulations of the N. Y .S. Racing & Wagering Board and with the provisions
of local licensing ordinances or laws.
5. That the undersigned has read and is fanliliar with the provisions of the Games of Chance Licensing Law as amended, the Rules and Regulations
of the N.Y.S. Racing & Wagering Board. and the local licensing ordinances or laws.
6. That no cOmnUssion, salary, compensation, reward or recompense will be paid to any person for holding or assisting in the operating or
conducting of the games, except to bookkeepers or accountants for professional services in an amount not exceeding that fixed by the Board.
[QliJ / 1/ Isl / 0Z1
Date
.5/fI/lI/J JJIo g/l!J L
Print Name
OF NEW YORK }
OF 'DUlL \-71~~~ 55
CITY/fOWNNILLAGE OF 1.J AfP I ()r~F. R
S r-::; L~\J JA~ Ilt ~^ oK being duly sworn deposes and says that (s)he is the person above named,
that (~has read the foregomg statement and the answer therein noted, and that such answers are true and that (s)he has personally
affixed his (her) signature to this affidavit.
STATE
COUNTY
Sworn to before me this
/ sH day of&4/,,;
. 20 oS'
S;g"~~~~
Notary Public
10;'30
I
Commissioner of Deeds
My Commission expires
. 20..!L.b.
fi:.ila(\
1):1<1-::(;1'. M:~LS
,'l. '" nf New YI,/I!.
,L
"",C()\Jll~1
,'I.ll,~
,>.!\ .:\;,.-,';'
L B,J-GC-2 (Rev. 4103)
Page 2 of2
IIIIIIIWIIUJI .J
..
r
GC-2A APPLICA TION FOR GAMES OF CHANCE LICENSE
NYS RACING & WAGERING BOARD
I Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Tclephone(SI8)4S3-8460 Fax(SI8)4S3-8492
www.racing.state.ny.us
-,
f J PGLf.
Name of Organization
GC- [iliJ - 0lEJ - ~ - ~
NYS Identification Number
SCHEDULE 1: OFFICERS AND DIRECTORS
List Dames. addresses and dates of birth of all officers.
If orpniZltioa is . corporation, or an iDCorporated or unincorporated lLSSOCiation. Iisl officers and directors.
( TITLE N~E DATJ;OFBIJrIlI STREET ADDRESS
~~€ AlJ~,1II/) 1-,.s7 1_1_1_1 I
I 1_1_1_' I
I 1_1_1_1 I
1 1_1_1_1 I
1 1_1_1_1 I
1 1_1_1_' 1
I '_1_1_1 I
I 1_1_1_' I
I 1_1_1_1 I
I 1_1_1_' I
1 '_1_1_1 I
Attach additionaJ sheet if necessary.
[ili]/~/[ill
Date
CITY
ZIP
SCHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST POUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF
NAME J. ~ OF BIRTH MEMBERSHIP STREET ADDRESS
(SII 1J/JIJC)lu IIi:m..I _I _I I
'_1_1_1 I
1_1_1_' I
'_1_1_' ,
1_1_1_' I
1_1_1_1 I
1_1_1_1 I
'_1_1_1 ,
1_1_1_' 1
CITY
ZIP
SCHEDULE 3: AUXILIARY/AFFlLIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 AUXD..IARIES/AFFD..IATES. EACH AUXllJARY/AFFD..IATI: LISTED MUST HAVE ITS OWN 10 NUMBER)
NAME O~Y/AFFILIATE
GAMES OF CHANCE ID NUMBER
L BJ-GC-1A (Rev.4J03)
Page] of2
11111111111 UI 11111 I .-J
Schedule 1: Officers and Directors
WAPPINGER LODGE #2609 OFFICERS for 2005-2006
Title Name Address Town Zip DOB
......---- -_.
Exalted Ruler Steve Drobnak 53 Moccasin Vaew Rd. Fishkill 12524 02/02/1957
Leading Kgn Pamela Kultsar 58 Hillis Terrace Poughkeepsie 12603 02/01/1950
LoyalKgn Derrick Mills Pawling Lake Box 17 Pawling 12564 10/10/1940
Lecl Kgn Sandra Seekamp 67 Pawling Lake Pawling 12564 12/10/1945
Esquire Mark H. Fox 28 Tiger Road Hopewell Jct. 12533 09/15/1957
Chaplain Diana M. Cole P.O. Box 549 Hughsonville 12537 04125/1948
Inner Guard Rosemarie Perretta 35 Cathy Road Poughkeepsie 12603 09/07/1943
Secretary Robert M. Acquanita 10 Vorndran Dr. Wappinger Falls 12590 OS/25/1942
Treasurer Richard O. Desruisseau 183 Red Cardinal Court Poughkeepsie 12603 11/05/1936
Tiler Jacqueline Alfano 93 Brothers Rd. Wappinger Falls 12590 08/27/1938
Trustee Patrick J. Moriarty 26 Robert Lane Wappinger Falls 12590 04116/1941
Trustee Paul U. Bader 366 Andrews Rd. Lagrangeville 12540 09/20/1965
Trustee Harris Jones 1 02 Broth~rs Road Stormville 12582 04/24/1944
Trustee Gerhard P. Stoetzel 662 Noxon Road Poughkeepsie 12603 05102/1942
Trustee Louis Antolotti 229 Robinson Lane Wappinger Falls 12590 06/23/1933
No Officer receives compensation of any kind.
1-
Schedule 2. Members in Charge of Games
LAST_NAME FIRST _MI ADDRESS City Zip DOB Yrs Member
--- -- ----
Antolotti Louis 229 RobinsQn Lane Wappiflgers Falls 12590 06/23/1933 10
Kaufman Simon 9 South View Ln. Hopewell Jet. 12533 08/16/1930 2
Bader III Paul u. 134 Andre\'lVl$ Rd. Lagrangeville 12570 09/20/1965 10
Boyer Jr. James R. 134 Andrews R~. Lagrangeville 12570 11/28/1937 22
I ~
r SCHEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE OF GAMES
Ust all mcmbcn of applicalll orpnization and mcmbcn of authori2lcd affiliates and auxiliary who will assist with gamc:a. Each person listed must be a
member of applicant OI'JIlIIlIZldOll or affiliate for Illcast I year.
YEARS OF
MEMBER NAME . I?A~ OF BIRTH MEMBERSHIP STREET ADDRESS CITY
(SIll AlTj)cflE~~ _/ _ I _ I I I
I / / '_I I I
'-/-/-1_' I I
'-/-/-1_' I I
,-/-/-,-, , I
'-/-/-'_1 I I
,-/-/-,-, I I
,-/-/-,-, I I
,-/-/-,-, I I
'-/-/-i_1 I I
'-/-/-:_1 I 1
'-/-/-,_1 I I
'-/-/-i_' I I
/-/-/-1_1 I I
,-/-/-,-, I I
'-/-/-'_1 I I
1-/-/-'_1 I I
1-/-/-'-' I I
'-/-/-'_1 I I
1-/-/-'_1 I I
,-/-/-,_: I I
'-/-/-'_1 I I
1-/-/-'_1 I I
'-/-/-1_1 I I
'-/-/-'_1 I I
'-/-/-'_1 I I
'-/-/-1_' I I
'-/-/-'_1 I I
1- /- /- I _ , I I
,-/-/-,-, , I
'-/-/-1_' , I
,- /- /- , - I I I
1- /- /- , _ I I I
'=/=/=1_1 I I
I
ZIP
L BJ-GC-1A (Rev. 4It3)
Attach additional sheet if necessary.
Page 2 of 2
IIn 111111I/11111 g IIII -.J
Schedule 4. Assistants to Members in Charge of Games
First MI
Frank
Philip A.
Ralph J.
Henry J.
Harold A.
Francis J.
Roger
Richard O.
Richard D.
Stephen F.
Robert
Mark H.
Harris C.
Robert J.
Joseph
William K.
Eugene P.
Rosemarie
Gregory F.
Kenneth J.
Robert N.
last Name
Abato
Abbate
Anzivina
Boldrin
Crawford Sr.
DeGano
DeJordy
Desruisseau
Dobbins
Drobnak
Fischetti
Fox
Jones
Ju1iano
Jurina
Minkowski PSVP
Pampalone
Perretta
Sarno
Tucker
Wallner
DOB Address
04/2411940 39 Kensington Drive
05/16/1937 6 Hackensack Hghts Rd
12/2111935 12 Thorns lane
01111/1936 28 Gold Road
02/23/1936 318 Sunset Hill East
07/18/1946 27 Brandy lane
09/1911944 83 Kent Road
11/05/1936 183 Red Cardinal Court
05/30/1949 6 Schuele Drive
02102/1957 53 Moccasin View Rd.
06/07/1926 91 Ardmore Drive
09/15/1957 28 Tiger Road
04/24/1944 217 Brothers Road
10/05/1953 2776 West Main Street
02/28/1963 173 Hillside lake Rd.
03/20/1942 427 McGrath Blvd.
09/03/1936 53 Helen Drive
09/07/1943 35 Cathy Road
07/01/1936 13 Dana Place
03/19/2029 34 Pawling lake
01/17/1933 7 Kinry Road
Town
Hopewell Jct
Wappingers Falls
Highland
Wappinger Falls
Fishkill
Wappingers Falls
Wappingers Falls
Poughkeepsie
Wappingers Falls
Fishkill
Wappingers Falls
Hopewell Jct.
Stormville
Wappingers Falls
Wappinger Falls
Fishkill
Wappingers Falls
Poughkeepsie
Wappingers Falls
Pawling
Poughkeepsie
Yrs an Elk
8
15
18
12
15
15
15
18
19
6
25
11
15
10
7
25
17
5
25
6
16
r
GC-2B APPLICATION FOR GAMES OF
NYS RACING &. WAGERING BOARD CHANCE LICENSE
1 Watervliel Ave, 6xt.. Suite 2
Albany, NY 12206-1668
Telephone (518) 453.8460 Fu (518) 453-8492
www.racing.state.ny.us
-,
GC- [ili] - [WE] - ~ - ~
NYS Identification Number
~/rn/~
Date
SCHEDULE 5 DA TES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPUCABLE FOR BELL JAR GAMES)
DATE
, /6 / a/.e.S':!.
.li / $...!i / . () ..5 ! .
) ~, / ,0 ,~ /.0 .S' ! .
, / . / !
./. . / . .! .
/ . . / . .! .
/ . / . !
,/ . . / . .! .
/ . /. .! .
, / , / !
,/ . . / . .! .
/ . / . .' .
RAFFLES
DATE
HOURS
,1,: 0 0 ami- .0 J ,:.0 0 .@/pm!$,
, 7 , :. 0 . 0 .am p -. 0 . ( ,:,0 P .€i>/ pm ! $ .
. 7,:, 0 . 0 .am p -. (). I ,:. 0 . 0 ,liP / pm ! $ .
. , am / pm - . . . am / pm ! $ .
, . , .am / pm - . , . . .am / pm ! $ .
,'. .am/pm - , ,'. .am/pm!$.
. . am / pm - . . am / pm ! $ .
.'. .am/pm - . .'. ,am/pm !$.
.:. ,am/pm - . .:. .am/pm !$.
am / pm - . , am / pm ! $
.am / pm - . . . . .am / pm ! $ .
.am/pm - . .:. .am/pm ! $.
RENT
.0..,00,
0.00
,
,('),.,O ,0,
. . .
, .
. . .
,-,
,-,
.-,
, . .
. . .
1-.
. . .
II)
I am / pm -
I . . . .. .
I am/pm -
I . . . . .
I am / pm -
I . . . .. .
I am / pm -
, . . . .. .
I am / pm -
I . . . .. .
SCHEDULE 6 EXPENSES
List items of expense to be incurred, and the names and addresses of persons to be paid.
ITEM OF EXPENSE VENDOR NAME STREET ADDRESS CITY
IJr~1L L /C.IN>~ $ R. h~I.I/J",TIJ Ie V'r>/.II.Ju# tJJ. tV~/P. /i1 Z~
cLiDN'!<I' K.. hi r~l)vAIl ,2 G, 111ft /Jkol< Lt,oP )/tJ/rdJt ::fe-I.
TIME
/
, / .
/
. / ,
/.
...
PRIZES (Cash or Fair Market
Value of Merchandise)
.am/pm · $ ,
.am/pm i $,
.am/pm '$ ,
.am /pm $
,am/pm $ ,
/
. / ,
/
/.
/
.. .
. . .
.-,
. . .
.-.
STATE
/Il. y.
/J.y.
ZIP
tx9~
/.2 5"13
L BJ-GC-28 (Rev. 4103)
Page 1 of2
1111111 111111111 111111111 .J
r SCHEDULE 7 TYPES OF GAMES -,
List all of the single types of games to be conducted at all license periods enumerated in Schedule 5.
Note for Vee:as Nie:hts and Bazaars onlv: The total amount of prizes during anyone license period shall not
aggregate more than $400 for each single type of game of chance when five types of games of chance are to be
conducted during anyone license period. The total amount of prizes during anyone license period shall not
aggregate more than $500 for each single type of games of chance when less than five single types of games of
chance are to be conducted during anyone license period.
LIST NAME OF EACH TYPE OF
GAME OF CHANCE
(Limit: 5 Games)
/jlAck- ~c K..
::ro klJ. Po U/!..
13/, SiX
LIST THE MAXIMUM AMOUNT OF PRIZES
TO BE AWARDED FOR EACH TYPE OF
GAME OF CHANCE (GAME BANK)
at $ SCJ(). 00
at $ 100. 00
at $ /00, 0 0
at $
at $
For Merchandise Wheels, Bell Jars and Raffles, please complete the appropriate spaces below.
MERCHANDISE WHEELS:
INDICATE NUMBER OF
MERCHANDISE WHEELS
(NO LIMIT)
tJ /;;
I
THE TOTAL AMOUNT OF PRIZES FOR
EACH MERCHANDISE WHEEL SHALL
NOT EXCEED $10,000 AND NO SINGLE
PRIZE SHALL EXCEED $250
BELL JAR:
INDICATE IF THIS APPLICATION
IS FOR A BELL JAR
LICENSE
YESO N01-
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BELL JAR DEAL SHALL NOT
EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500
RAFFLES:
TNDlCA TE IF THIS APPLICA nON
IS FOR A RAFFLE
LICENSE
YESD NO ~
IF YES, LIST RAFFLE DATES, TLME(S)
OF DRA WING(S) AND PRIZES IN
SCHEDULE 5
THE TOTAL AMOUNT OF PRIZES FOR
ALL THE RAFFlES CONDUCTED DUR-
ING THIS CALENDAR YEAR SHALL
NOT EXCEED $100,000. NO SINGLE
PRIZE SHALL EXCEED $50,000
EXCEPT THAT A SINGLE PRIZE OF
$100,000 MAYBE AWARDED IF SO
INDICA TED IN SCHEDULE 5
L BJ-GC-2B (Rev. 4103)
Page 2 of2
1111111111111111 -.J
r
GC-4
NYS RACING & WAGERING BOARD
I Watervliet Ave. Ext., Suite 2
Albany. NY 12206-1668
Telephone (5]8)453-8460 Fax (518) 453-8492
www.racing.state.ny.us
--,
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC- [illJ- [&ill] - ~ - ~
N.Y.S. Identification Number .
-rL;U.JN ~I iJ/JlfJlAlGE~
Name of Municipality
,...
//f5 L-rl,g7~
Address
lU/ffJf1/Alt:~-,.es FA?L- 5
",
/ ,? S/~
AI c./
I
Law, the following findings and determinations
After investigation, and a hearing if required under Sec. 192 of the General
have been made:
I. All the members-in-charge designated in the ap
character and have never been convicted of cri
Signature of Person Conducting Investigati
~s
DNo
Title
/
~\*
2. Applicant is a qualified authorized organizati n 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 ;rre 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 to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
!If Yes DNo
l!I Yes DNo
rzfYes DNo
u1 Yes DNa
ri Yes DNo
rn Yes DNa
r!I Yes DNo
JtI Yes DNa
DYes DNa
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED~; licens
Signature of
Filing date of Application Authorized Officer
Date
Title
Town Clerk
'censing Authority)
ONE COPY OF TIllS 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) -111111111111111I1111111111111 ~
---,
i
r
GC-4
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.lIs
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
--,
GC-fZ0-0ZI1J-~-~
N.Y.S. Identification Number .
~u.:;AI ~I !JA-;1fJ1/i1GE~
Name of Municipality
"
II f 5 L.-I-.,g7 ~
Address
Aft/ /~S7()
I
t..J fi fJ fl / AI' 6-e-,e,.:s ;:'A ~L, ~
",
Law, the following findings and detenninations
~s DNa
1. All the members-in-charge designated in the ap
character and have never been convicted of cri
Signature of Person Conducting Investigati
Title
./
~\\tt
2. Applicant is a qualified authorized organizati n 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 ?Te 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 Lawand..the.Rulesand 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
gi ven 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 to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
rr6 Yes DNo
l!1 Yes DNa
I2f'Yes DNo
n1 Yes DNa
ri Yes DNo
Eli Yes DNo
[!'] Yes DNo
R1 Yes DNa
DYes DNo
TO BE COMPLETED BY MUNIClPAL CLERK:
As a result of the findings and detenninations stated above, license is GRANTED~; licens
Signature of
Filing date of Application Authorized Officer
Date
Title
Town Clerk
"tensing Authority)
ONE COPY OF TIllS FORM TOGETHER VVITH 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) -lllIi /11111111111111111111111 --1
r
GC-4
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
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
I
GC-l2m - rmJ1J - IiliIIl- ~
N.Y.S. Identification Number .
-r;; u.;J AI ~I UA-f1 /I /J/GE ~
Name of Municipality
~
II f 5 L.-rl 57 ~
Address
A/c./
(
/ ~ S7tJ
/U.It PI' / A/6-L:-~.s FA bL, :;
'"
Law, the following findings and determinations
~s
DNa
1. All the members-in-charge designated in the ap
character and have never been convicted of cri
Signature of Person Conducting Investigati
e are. of good moral
//
Title ~ \ tt
2. Applicant is a qualified authorized organizati n 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 andlhe.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 ofthe N.Y.S. Racing and Wagering Board.
8. There is satisfactory proof that the type and value of prizes offered and gi ven will be in accordance with the
provisions of the Games of Chance Licensing Law.
9. If applicable, the rent to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
ll6 Yes DNa
EI Yes DNa
ri'Yes DNa
Ii Yes DNa
Ii' Yes DNa
rn Yes DNa
ti Yes DNa
RI Yes DNa
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and detemiinations stated above, license is GRANTED J(J; licens
Signature of
Filing date of Application Authorized Officer
Date
Town Clerk
'censing Authority)
. Title
ONE COPY OF TIllS 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~ (Rev. 4/03) .//1I111111! II 1/1111111111/11/ --.J
I
GC-4
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
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
I
GC - [2]ZJ- C&ZJIJ - [iliB] - ~
N.Y.S. Identification Number .
--r;; Lt.!) AI ~I iJA-~ /I /J!G6- ~
Name of Municipality
"
// f 5 L--f-#,g7 (.
Address
/,(S7~
I.c.J fi fJ f1 / Al6 ~-;e.s FA i!-L. 5
'"
AI ,-I
I
Law, the following findings and determinations
e are. of good moral ~s 0 No
1. All the members-in-charge designated in the ap
character and have never been convicted of cri
Signature of Person Conducting Investigati
Title
2. Applicant is a qualified authorized organizati n 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?Te 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 ChanceLicensing Law and.1heRules 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. to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
o Yes DNa
~Yes DNa
rz( Yes DNa
Ii' Yes DNa
ri Yes DNo
rn Yes DNa
I!5 Yes DNo
ltI Yes DNo
DYes DNo
I
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED~; licens
Signature of
Filing date of Application Authorized Officer
Date
. Title
Town Clerk
'censing 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.
.1111111]111111111111111111111 -.J
BJ-GC-4 (Rev. 4/03)
r
GC-4
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ex1., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
I
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC- [ill] - [ill]fJ - ~ - ~
N.Y.S. Identification Number .
/'L; u!) AI ~I tJAI jJj /lIGE ,6
Name of Municipality
"
//95 L-I-.J'7~
Address
t.J fi fJfl /Alt:t:-AtS r A /-L. S
'"
/1/(../ / :? Sf"
I
Law, the following findings and determinations
1. All themembers-in-charge designated in the ap
. character and have never been convicted of cri
Signature of Person Conducting Investigati
~s
DNo
Title
.,/
-~ r r
~\n
2. Applicant is a qualified authorized organizati n 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 !lIe 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 andJ:he 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 to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
[!] Yes ONe
I!JYes DNo
rz{ Yes DNo
Ii Yes DNa
ri Yes DNa
u1 Yes DNa
Iti Yes DNa
JtJ Yes DNa
DYes DNa
) .
TO BE COMPLETED BY MUNICWAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED~; licens
Signature of
Filing date of Application Authorized Officer
Date
. Title
Town Clerk
.censing Authority)
ONE COpy OF TIllS 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) .11111111111111111]11111111111 .-J
r
GC-4
NYS RACING & WAGERING BOARD
1 Waterv1iet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
I
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC - 0I] - [&Zill- [iliEJ - ~
N.Y.S. Identification Number ·
-T;; uJ AI ~I /JIJI flJ //IGE h
Name of Municipality
llni' Law, the following findings and determinations
~
I
~s DNa
t-
/,?s'/o
//fS L:r- J7~
Address
6.JftfJfJ/AI~t:-;.(S FA ~.L, :;
'"
AlL/
I
After investigation. and a hearing if required under Sec. 192 ofthe General
have been made:
1. All the members-in-charge designated in the ap "c
character and have never been convicted of cri
Signature of Person Conducting Investigati
Title
/'
~\Tt
2. Applicant is a qualified authorized organizati n 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 ?Ie 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 to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
rtf Yes DNo
I!i Yes DNa
lif'yes DNa
Ii Yes DNo
ri Yes DNo
rn Yes DNo
~Yes DNo
!tI Yes DNa
DYes DNa
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED~; licens
Signature of
Filing date of Application Authorized Officer
Title
Town Clerk
"tensing Authority)
Date
ONE COpy OF TIllS 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-GC4 ",",. 4103)11111111111111111111 ~ ID I~I .-I
r
GC-4
NYS RACING & W AGERlNG BOARD
1 Watervliet Ave. Ext, Suite 2
Albany. NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
I
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC -1Z0 - [illill- [ilill] - ~
N.Y.S. Identification Number ·
-T;; it:; AI tJl iJA-1 /I /JIG E ,e.;
Name of Municipality
o
Municipal License Number
Law, the following findings and determinations
e are. of good moral ~s 0 No
"
/.;S?o
/1'15 L,.f- 4 .J 7 (.
Address
tU .A- fJ f1 /.Aft: ~-;(:5 FA?t. S
'"
AIel
I
After investigation, and a hearing if required under Sec. 192 of the General
have been made:
I. All the members-in-charge designated in the ap
character and have never been convicted of cri
Signature of Person Conducting Investigati
Title
//
~ex-\ 4
2. Applicant is a qualified authorized organizati n 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 ?1"e 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 and1he.RuIes and Rezulations 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. to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
III Yes oNo
r!I Yes DNo
Ii Yes oNo
ri Yes ONe
r::i Yes ONe
rn Yes DNo
rtI Yes DNo
JtJ Yes oNo
DYes oNo
) .
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the fmdings and detemiinations stated above, license is GRANTED;(I; licens
Signature of
Filing date of Application Authorized Officer
~~
Date
. Title
Town Clerk
'censing 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 nJ-GC-4(R~- 4IO"IIIIIIIIH 1IIIIIIm 11111 1m ~
r
GC-4
NYS RACING & WAGERING BOARD
1 Waterv1iet Ave. Ext, Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
--,
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
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N.Y.S.Identification Number ·
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Name of Municipality
"
510
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A ~." 5
,/
Law, the fDllowing findings and determinatiDns
e are. of good moral ~s 0 No
1. All the members-in-charge designated in the ap
character and have never been cDnvicted of eri
Signature of Person Conducting Investigati
/'
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Title
2. Applicant is a qualified authorized organizati n as defined in the Games of Chance UcensingLaw.
3. All the members designated in the application to conduct games are bona fide active members ofllie applicant
organization.
4. The premises presently owned or occupied by the applicant are in every respect adequate and suitable for
CDnducting games Df chance.
5. The games of chance are to be cDnducted 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 tD one ore more of the "lawful purposes" as defined in the
Games of Chance Licensing Law and the Rules ahd Regulations of the N.Y.S. Racing and Wagering Board.
7. There is satisfactory proof that nD 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 to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
Lli Yes DNo
I!J Yes DNo
Ii' Y es DNo
ri Yes DNo
r:i Yes DNo
ui Yes DNo
I!J Yes DNo
00 Yes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated abDve, license is GRANTED~; licens
Signature of
Filing date of Application August 9. 2005 Authorized Officer
Date
August 18. 2005
Title
Town Clerk
'tensing Authority)
ONE COpy OF TIllS 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.
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NYS RACING & WAGERING BOARD
1 Waterv1iet Ave. Ext, Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC -1Z0 - cmm - [ili:0 - [illillillJ
N.Y.S. Identification Number ·
-tLJuJAI t?1' 0/11/J/tGE ~
Name of Municipality
Law, the following findings and determinations
e are. of good moral ~s 0 No
,...
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-f#.17~
tUftfJf1/N'6e~
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./
After investigation, and a hearing if required under Sec. 192 of the General
have been made:
1. All the members-in-charge designated in the ap . c
character and have never been convicted of ri
Signature of Person Conducting Investigati
Title
/
~\\~
2. Applicant is a qualified authorized organizati n 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 ~e 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 to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: . (Specify)
~Yes DNo
r!I Yes DNo
rzf Yes DNo
ri Yes DNo
Ii Yes DNo
rn Yes DNo
iJ Yes DNo
!tl Yes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED~; licens
Signature of
Filing date of Application Augus t 9, 2005 Authorized Officer
Date
August 18, 2005
Title
Town Clerk
. ensing Authority)
ONE COPY OF TIllS 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.
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