Wappinger Elks Lodge (4)
I
GC-5
-,
NYS RACING & WAGERING BOARD
I Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (518) 347-1469
www.racing.state.ny.us
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE D
BELL JAR ~
RAFFLE D
GC - [iJ;] - GIiliJ - GIQJL] - GL:IiliLJ
N.Y.S. Identification Number
i-:P,
This License Must Be
Conspicuously Displayed
During Conduct of Games
$1 25 .00 II
Amount of Fee Paid Lessor's License Number
Address: 1195 ROllte 176 City: Wappingen; Fa] 1 R
Entire net proceeds to be devoted to the following specific lawful purpose(s):
Charity.Patriotic. Youth. Educational
Names of Members in Charge
Paul Bader
Zip Code:12590
Simon Kaufman
Lewis Hakim
Greg Sarno
LICENSE PERIOD
DATE
DAY OF WEEK
HOURS
TYPE(S) OF GAMES
RAFFLE DRAWING
DATE
DRAWING TIME DRA WING LOCATION
AMOUNT OF RAFFLE PRIZES (Cash or Merchandise Prizes
at FaIr Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
$
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
NUMBER OF GAMES
EACH GAME (Starting Bank)
NUMBER OF WHEELS
EACH WHEEL
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
ST A TE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
Issued by Town of Wappinger
(Name of Municipality)
(SIgnature of Authorized Officer)
11111111111111111111I\ 11\1 \1\ ..J
April 13, 2009
(Date)
L BJ-GC-5 (Re\'. 3/06)
r
GC-4
NYS RACING & WAGERING BOARD
1 Waterv]iet Ave. Ext., Suite 2
A]bany, NY 12206-]668
Telephone (51 8) 453-8460 Fax (5] 8) 453.8492
www.racing.state.ny.us
I
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHAN'cE
LICENSE
GC-EGJ-ITLJ-~-~
N.Y.S. Identification Number Municipal License Number
Town of Wappinger
Name of Municipality
1195 Routp 376. WappingersFalls. NY 12590
Address
After investigation, and a hearing if required under Sec. 192 of the General Municipal Law, the following findings and determinations
have been made:
1, A1l the members-in-charge designated in the pli
character and have never been convicted a c
Signature of Person Conducting Investigati
SHERIFF
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 Garnes 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 Garnes of Chance Licensing Law.
9. If applicable, the rent Lo be paid to an authorized games of chance lessor is reasonable.
IO. Other findings: (Specify)
[2('Yes 0 No
lXI Yes DNa
IXI Yes DNo
IXI Yes DNo
2m Yes DNa
[Xl Yes DNo
mg Yes DNo
[]I Yes DNo
[1g Yes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED G:(license is DENIED 0
Signature of
Filing date of Application 03/26/09 Authorized Officer
Date 03/26/09 Title Tm.Tn r.l pr'k- ,.,f T,T~FpiRg9r
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 "-Gc.4 (Ro>. 4/03) 11111111111111111111111111111 ..J
I
,GC-2
I
NYS RACING & WAGERING BOARD
] Watervliet Ave. Exl., Suite 2
Albany, NY 12206-]668
Telephone (518) 453-8460 Fax (5] 8) 453-8492
www.racing.state.ny.us
APPLICA TION FOR:
PLEASE CHECK
GAMES OF CHANCE 0
BELL JAR M
RAFFLE 0
FOR OFFICE
USE ONLY
$125.00 I rn/G]J/Q
Fees Received Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC- [ZliJ- [ililiJ- ~- G2JiliJL0
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN TillS APPLICATION
'Ii uW d F I( / ~ f) '~f~ s J)if7!Ue f..5
Name of MUllicipality , County
PART A. GENERAL
1. Name of Or anization
-L k.5 #2/..
2. Address tU ~p,r;t//f az.- /ij;jff I.2S?' t:J
3. Has applicant ever been denied a games of chance license? 0 Yes ~No If "yes", why? (Attach extra sheet if necessary)
4.
Check type of organization and, if applicable, give the State and date of incorporation.
Corporation 0
State incorporated
Incorporated Associati on 0
Unincorporated Association 0
Date IT] / IT] / IT]
Date IT] / OJ / OJ
State incorporated
Individual
o
5. Did your corporate status change since your identification number was assigned? 0 Yes 0 No
6. Are you doing business under a trade name? 0 Yes ,rx[No If "yes", what is the trade name?
PART B. LOCA TION OF GAMES
7. Address where games, bell jar, or raffle drawing(s) are to be conducted. /Jlif IllJwJe .3 7 "
,
8. Name and address of authorized games of
chance lessor renting to applicant.
,t( Jr-
10. Capacity for public assembly of premises presently owned or occupied.
,,;2 3 y~
I
3'1tJ
.
9. Does the applicant own the premises? ~ Yes 0 No If "yes", how long?
11. Have premises been regularly used? ~ Y es 0 No If "yes", how long?
Are games of chance being played now on these premises or has it ever been? 0 Yes 0 No If "yes", give full details.
12. Are the premises or any part thereof
where games of chance are to be played
licensed by the State Liquor Authority?
~Yes
DNa
If "yes", state the type of license and number.
Cl... W ft> L:r=ql.j t./L i.../~c:4/>E -It-- c1t,c Y' ....::: 1J'1k {!.L 7t./;ish
13. Has such license ever been
revoked or suspended? 0 Yes
rlNO
If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
. .
R.T-GC-2 (Rev. 4/03)
Page 1 of2
11111111111111111111111111111 ~
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I
PART C. PURPOSES OF GAMES
] 4. State the specific purposes for which the entire net proceeds are to be devoted and in what manner.
/iJ~ '.-r;. /I .' t1, ~d# ~
1..7/ r, '1 ,r~;Cp:'/Le 11/-4'/';' e. . 'd..1--r7':7JA/~
, I /
I swear (or affirm):
1. 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,
operated 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 laws, 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.
IDI51/1~~I/~ ~~
Date Signature of H ad of Organization
OF NEW YORK
OF ;j~ />2J
OF ;}I?r~kf-EA /~{/,
/?~ c e. {,I i/4--'1 eA/ Te:-
Print Name
STATE
}ss
COUNTY
CITY rrOWNNILLAGE
. 6' CC (J V4 ie vi -<- being duly sworn deposes and says that (s )he is the person above named,
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.
20 d I
,
Signed
Commissioner of Deeds
/
/
/
, 20 tJ I'
BJ.GC.2 (Rev. 4/03)
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Page 20f2
1111111I1111111111I [I lllll III .J
r-
. GC-2A APPLICATION FOR GAMES OF' CHANCE LJiCENSE
NYS RACING & V/AGERING BOARD
] Waterv]iel Ave. EXl., Suite 1
Albany, NY 12206-1668
Telephone (5] 8) 453-8460 Fax (518) 453-8492
www.racing.state.ny.lIs
r
/\NIAlpip/'/N/G/E/lLIE-/L/K/sl ILlo/~216IoI91
~ization
GGJ/Q]/GI;]
Date
GC- GJ2] - /2/1 I~ - I 61 0121- [Qhh~
NYS Identification Number
~CHEDULE 1: OFFICERS AND DIRECTORS
.ist names, addresses and dates of birth of all officers.
f organization is a corporation, or an incorporated or unincorporated association, list officers and directors.
TITLE NAME DATE OF BIRTH STREET ADDRESS
1_1_1_1
1_1_1_'
1_1_1_1
1_1_1_1
1_1_1_1
I_I_/~I
1_1_1_1
1_1_1_1
1_1_1_1
1_1_1_1
1_1_1_1
Attach additional sheet if necessary.
I
!
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"'1
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I
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I
I
CITY ZIP
I J I
I I
I I
I ,
j I
I I
I I
I I
I I
I I
I j
;CHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DAlE YEARS OF
NAME OF BIRTH 1v1EMI3ERSHIP STREET ADDRESS CITY ZIP
I_I_I_J I I I
)aul Bader I 91 20 11965 I 14 I 134 Anderews Rd jlaGrange I 12540
:;imon Kaufman ,---a I~ 1 1930 I 7 I 9 S. View Ln I Hopewell Jet I 12533
.ewis Hakim I 71 27 1 ...m45-1 6 1 28 QUGOR AfIRe lr1 I Wappingp-ffi. F::lII;: I 12590
3reg Sarno , -----L. 1 ~ 1 1936/ 28 I 1 ~ O::lP<:l Place I W::lppingerg F311E 1 12690
1_1_1_1 I I I
1_1_1_1 I I I
1_1_1_1 I I I
I - 1 - 1 - I I I I
;CHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 A UXJLIARIES/ AFFJLlA TES. EACH AUXJLlAR Y/ AFFILIATE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXILIARY I AFFILIA 1E
GAMES OF CHANCE ID NUIYlBER
nJ-GC-2A (Rev. 4/03)
Page lof2
11111111 11111111111111 IJ 1I1I1 ~
Schedule 4 Assistants to Members in Charge of Games
First MI
Frank
Philip A
Ralph J
Henry J.
Harold A
FrancIs J
Roger
Richard 0
Richard D.
Stephen F.
Roben
Mark H.
Harris C
Raben J
Joseph
William K
Eugene P
Rosemarie
Gregory F.
Kenneth J.
Roben N
Last Name
Abato
Abbate
Anzivina
Boldrin
Crawford Sr.
DeGano
DeJordy
Desruisseau
Dobbins
Drobnak
Fischetti
Fox
Jones
JuHano
J urina
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 Couri
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 Jet.
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
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. Fis h kill 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 Jet. 12533 09/1511957
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/2511942
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
. Tr-Iotu PStjl W. &.J~. anll A. .{I. en.,. I\d. Ld~1 ClIII~t:YIlIt: I.L~U U;1I.LUI I ~o>J ~
Trustee Harris Jones 102 Brothers Road Stormville 12582 04124/1944
Trustee Gerhard P. Stoetzel 662 Noxon Road Poughkeepsie 12603 05/02/1942
~ T _00_"_ _ ~_. ..' ...~...... .. . ... rrl ... ~1I -liil T~TI"I-- ..
No Officer receives compensation of any kind.
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COLSEY
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
March 27,2009
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, New York 12601
Dear Sheriff Anderson:
Enclosed, please find a copy of Members in Charge" for Wappingers Elks 2609, 1195
Route 376, Wappingers Falls, New York, who will be selling BELL JAR Tickets on their
premises throughout the year 2009.
I would appreciate your review of the application. Please complete the "Findings and
Determination" form attached and return the completed application to my office.
Thank you for your attention to this request and your prompt reply.
Sincerely,
J hn . Masterson
Town Clerk
Town of Wappinger
r
GC-4
NYS RACING & WAGERING BOARD
] Wnterv]iel Ave. Exl., Suite 2
Albany, NY 12206-1668
Telephone (5 J 8) 453-8460 Fax (518) 453-8492
www.racing.stllte.ny.us
-,
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
GC-CLGJ-~-~-~
N.Y.S. Identification Number
Town of Wappinger
Name of Municipality
1195 Route 376. WappingersFalls. NY 12590
Address
After investigation, and a hearing if required 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
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.
S. 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 La be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
DYes 0 No
lXI Yes DNa
!Xl Yes DNo
!XI Yes DNo
~Yes DNo
!XI Yes DNo
mg Yes DNo
!]I Yes DNo
I29 Yes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED 0; license is DENIED 0
Signature of
Filing date of Application 03/26/09 Authorized Officer
(Municipal Licensing Authority)
Date
03/26/09
Title
Tnum r.lp~k nf ~appiRg9r
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 atev. 4/03) 11111111111111111111111111111 .-.J
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COlSEY
TOWN CLERK'S OFFICE
20 MIDDlEBUSH ROAD
WAPPINGERS FAllS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WilLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOlONI
April 13, 2009
Wappingers Elks #2609
1195 Route 376
Wappingers Falls, NY 12590
Dear Mr. Valente:
Please find the attached Bell Jar "License to Conduct Games of
Chance" for the year 2009. I have also attached a receipt for your payment.
Please do not hesitate to contact my office with any further questions
or concerns.
Sincerely,
JCM/cf
ROCCO VALENTE 04/06
61 FISHKILl HOOK RD
HOPEWELL JeT, NY 12533-6416
For
I: 0 2 . ~ . ~ }. 0 ~ I: L, 0 0 2 20 b L, 58111
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