Wappinger Elks Lodge (5)
r
GC-5
NYS RACINe; & WAGERING BOARD
I Broadway Center. Suite 600
Schenectady. NY 12305-2553
Telephone (5]8) 395-5400 Fax (5]8) 347-]469
www.racing.state.ny.us
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE ~
BELL JAR 0
RAFFLE 0
~
I
J~"
~l~
'1":Z>>
c
GC - ill - CU!TI- [ililiJ-
N.Y.S, Identification Number
This License Must Be
Conspicuously Displayed
During Conduct of Games
$/ 25.00 II
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):
Zip Code: 12590
1 / 1 c'h.q ri t .q h 1 p
Names of Members in Charge
7/1 Oppr.qtinn",
Pim1 'RRrlpr'
Simon Kaufman
Lewis Hakim
Greg Sarno
LICENSE PERIOD
DATE
DAY OF WEEK
HOURS
TYPE(S) OF GAMES
May 1,?009
RAFFLE DRAWING
DATE
DRA WING TIME
DRAWING 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
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
STATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
Issued by Towm of Wappinger
(Name of Municipality)
(Signature of Authorized Officer)
11111111111111111 II 1111 II11I1 .-J
04/02/09
(Date)
L BJ-GC-5 (R;," 3/06)
r
GC-4
NYS RACING & WAGERING BOARD
] Watervliet Ave. Ext., Suite 2
Albany, NY ] 2206-1668
Telephone (5 18) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
I
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
GC - rn- GIlI2J - UIJ - ~
N.Y.S. Identification Number
Town of Wappin~er
Name of Municipality
. 1195 Route 376 Wappinger~ Fall~,NY l~~qO
Address
After investigation, and a hearing if required under Sec. 192
have been made:
1. All the members-in-charge designated in the pI' a
character and have never been convicted 0 a c'
Signature of Person Conducting Investigati
unicipal Law, the following findings and determinations
iii Yes 0 No
Sheriff
2. Applicant is a qualified authorized organi
3. All the members designated in the application to conduct games are bona fide active members of the applicant
organization.
4. The premises presently owned or occupied by the applicant are in every respect adequate and suitable for
conducting games of chance.
5. The games of chance are to be conducted in accordance with the provisions of the Games of Chance Licensing
Law, the Rules and Regulations of the N.Y.S. Racing and Wagering Board, and local ordinances.
6. The entire net proceeds are to be devoted exclusively to one ore more of the "lawful purposes" as defined in the
Games of Chance Licensing Law and the Rules and Regulations of the N.Y.S. Racing and Wagering Board.
7. There is satisfactory proof that no commission, salary, compensation, reward or recompense will be paid or
given to any person for conducting the games or assisting therein, except to the extent authorized by the Games
of Chance Licensing Law and the Rules and Regulations of the N.Y.S. Racing and Wagering Board.
8. There is satisfactory proof that the type and value of prizes offered and given will be in accordance with the
provisions of the Games of Chance Licensing Law.
9. If applicable, the rent to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
KI Yes DNo
19 Yes ONo
19 Yes DNo
~Yes DNo
KI Yes DNo
I[] Yes DNo
KI Yes DNo
E9 Yes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED fit license is DENIED D
Signature of
Authorized Officer
3/24/09
Filing date of Application
Date 3/25/09 Title Town Clerk of W::IppingPT
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 DJ-GC.4 mev.4/03) 11111111111111111111111111111 .-J
r.
GC-2A
I
APPLICATIOI\ FOR GAMES OF CH...<L1'./CE LICR~SE
NYS RACING &. WAGERING BOARD
1 WatervIie: Ave.. Ex:., Suite 2
Albuny, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state..ny.ll'S
IWjA/P!Pjl!N/GjE/R! /E.IL/KlsJ /L/%IGIEI216Io/91
Na..:ne o'Organization
G;}J/Q]/GG]
Date
GC- [iliJ - 12 /1 I~ - I 6/ 0 /2 I-I 0 I 2/ 0 I 1 r~
J\YS Identification Number
~CHEDULE 1:
OFTICERS kND DIRECTORS
.is: name:, addr::ss::;; and dates of birth 0: ali ofiic::rs.
. organiZ<ltion is a corporation. or 0lI1 in:orporatcd or unincorporated association, lis[ officer:; and dire:tors.
TI1LE NAlvfE DATE OF BIRTH STREET ADDRESS
1_1_1_1
1_1_1_1
1_1_1_1
I_I _I_I
1_1_1_1
1_1_1_'
I_I _1_'
1_1_1_1
1_1_1_1
1_1_1_1
'_1_1_'
I
I
I
I
I
I
I
I
:
I
I
I
CITY ZIP
I I
I
I i
I I
I I
i I
I I
I I
I !
I I
I
I
Attach additional sheet if necessary,
N.AJ\1E
MEMBERS LN CH..4..RGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGAl\iiZATlON)
DATE )rE.ARS OF
OF BIRTII 1vIElvffiERSHIP STREET IWDRESS
I I I I I
1-91 --w- I 1965 I 14 ! 134 Anderews Rd
,'---a/~1 1930 I, 7 ,I
9 So View Ln
I 7 I 27 I 194::; I 6
I 7 I 01 I 1936/ ?8
1-1-1-/
/-/-1-1
/-1-1-'
-1-1-/
CITY
ZIP
;CHEDULE 2:
1 ~ n;:!n? PI~C"..,
I
I laGrange
I Hopewell Jet
I Wappingprs F;:!II"
I
I W"rpi'lg.m: F311E
I
I
I
I
12540
Paul Bader
p;mon Kaufman
12533
tewis Hakim
~reg Sarno
28 Quean .'\Anc Ln
12590
~25::xJ
CHEDULE 3: AlTXILIARY/AFFILIATE ORGA,...~IZATIONS ASSISTING AT GAMES
(tv! AXfMUi',l 0<0:: A UXILIAR ESf!\FFILLA TES EACC-; A UXLLi.J'. Y; AFFLL'I. T; LlSTED MUST HAVE ITS OW", ID NUM!33P..)
.
I\.t...ME OF AU);]l.lA.RYI.A,.r~lL\.TE
GJUvIES OF Cl-L~NCE ill :NUlv1BER
r;J . GC.::?A (Rey. 4/03)
P2.ge 1 0[2
1111111111lJlIl II Jill! Ii 11I11 ~
:scheClUle 4. Assistants to Members in charge of Games
Years
First MI Last Name Address Town Elk DOB
Frank Abato 39 Kensington Drive Hopewell Jct 11 04/24/1940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 18 05/16/1937
Robert Acquanita 10 Vorndran Drive Wappingers Falls 22 OS/25/1942
Ralph J. Anzivina 12 Thorns Lane Highland 22 12121/19~5
Henry J. Boldrin 28 Gold Road Wappinger Falls 15 01/11/1936
Harold A. Crawford Sr. 318 Sunset Hill East Fish kill 18 02123/1936
Francis J. DeGano 27 Brandy Lane Wappingers Falls 18 07/18/1946
Roger DeJordy 83 Kent Road Wappingers Falls 18 09/19/1944
Robert Fischetti 91 Ardmore Drive Wappingers Falls 28 06/07/1926
Mark H. Fox 28 Tiger Road Hopewell Jct. 14 09/15/1957
Harris C. - Jones 217 Brothers Road Stormville 18 04/24/1944
Robert J. Juliano 2776 West Main Street Wappingers Falls 13 10/05/1953
William K. Minkowski 427 McGrath Blvd. Fishkill 28 03/20/1942
Rosemarie Perretta 35 Cathy Road Poughkeepsie 8 09/07/1943
Gregory F. Sarno 13 Dana Place Wappingers Falls 28 07/01/1936
Kenneth J. Tucker 34 Pawling Lake Pawling 9
Robert N. Wallner 7 Kinry Road Poughkeepsie 19 01117/1933
Schedule 1: Officers and Directors
'{)..oo (1 - ~o t (9
WAPPINGER LODGE #2609 OFFICERS for 2Q9O"'20Q9
Title
---------------------- --------------- --------------...----------- ------------------------------
Name
Address
Exalted Ruler
Leading Kgn
LoyalKgn
Lect. Kgn
Esquire
Chaplain
Inner Guard
Secretary
Treasurer
Tiler
Trustee
Trustee
Trustee
Trustee
Trustee
Joseph P. Havelka Sr.
Eileen E. Boyer
Diana Cole
Paul Bader
Mark H. Fox
Catherine Rohling
Rosemarie Perretta
Robert M. Acquanita
Pamela S. Kultsar
Susan Dorler
James Boyer
Rocco Valente
Alex Czarniecki
Alfred DeRose
Vacant
38 Hickory Lane
134 Andrews Road
P.O. Box 549
134 Andrews Road
28 Tiger Road
54 Brothers Road
35 Cathy Road
10 Vorndran Dr.
58 Hillis Terrace
21 Valley Road
134 Andrews Road
61 Fishkill Hook Rd.
31 Helen Drive
25 Hickory Lane
No Officer receives compensation of any kind.
Town
Pawling
Lagrangeville
Hughsonville
Lagrangeville
Hopewell Jet.
Wappinger Falls
Poughkeepsie
Wappinger Falls
Poughkeepsie
Wappinger Falls
Lagrangeville
Hopewell Jet.
Wappinger Falls
Pawling
Zip
12564
12540
12537
12540
12533
12590
12603
12590
12603
12590
12540
12533
12590
12564
DOB
11/13/1942
01102/1943
04/25/1948
09/20/1965
09/15/1957
04/22/1940
08/07/1943
OS/25/1942
02/0111950
03/29/1939
11/28/1937
06/06/1941
10/16/1941
11/28/1961
r SCii.KOULE 4: ASSISTANTS TO MEMBERS IN CHARGE o.F GAMES
List ali memi>er:; oi appliCllllt organization and members oi authorized affiiintes and auxiiiary who will assist with games. Each person listed musi he n
--,
~
!tJ-Gr-7A m"". 31l!6)
n'~m~!' f}f ~rr>!i(~~nt f!ft3~niz~~f!m or !imH~t~ fc!" ~t !e.q~t ! y~r.
I' ,
I /
---/-,---
---
/ I
I I
-/-/-
'r l
-/-,-
- /-/-
I I
-/-,-
1-/-/-
--~!- ,- ,- I
1_'_'- I
i i i i
i I ~. .
1-'-/- !
J I I
_i~_~_ 1
! I
-/-,-
i J
I I
i.
1
I
I
.
I
I
I
YEARS OF
r-,,1Er..-ffiSR N.,\ME DATE OF BIRTH I\:1EI\:1BERSHIP STREET ADDRESS
i / I I I
,'-j-'- ! I
LS~rz- i ~[~~)
1_/_/_1
. i / j
-/-/-1
-/- J- I
,
!
(
!
.
!
!
I
I !
. .
---
!
i
f
:
!
!
!
!
I !
'-'f- ,-
i J
Au.acn aridhioilai sheet if necessary.
Pugc20f2
ro T'T"V
'--.l;' .I.
rmJ!!~'ll f~ J!1 ~~lfIm
P~:ijg[ m1iF' r' f!......'.i~,~.:.I;~j
~._. ~ .....; ;:',,0..';--- .
7m
"""'u
.
,
,oJ
-
r'
GC-2
I
NYS RACING & WAGERING BOARD
I WlItervliet Ave. Ex\., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
APPLICATION FOR:
PLEASE CHECK I
GAMES OF CHANCE ri
BELL JAR 0
RAFFLE 0
FOR OFFICE
USE ONLY
$\
J"i 00
Fees Received
[QL] / GLJ / rn
Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC - [illJ- 00I9l- ~- ~
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
lOl.t.7M G tfZ W~fPpJ~1V'<- OvTCvtFZ.c:'S
Name of Municipality County
2.
3.
If "yes", why? (Attach ex.tra sheet if necessary)
4. Check type of organization and. if applicable. give the State and date of incorporation.
Corporation 0
rx.. State incorporated \.l- ~ -J G h \~
Incorporated Association ,.... __ ,- l ~,
Unincorporated Association 0
State incorporated
Date [ill] / [ili] / m
Date OJ / OJ / OJ
Individual
o
5. Did your corporate status change since your identification llt1~r was assigned? 0 Yes ~o
6. Are you doing business under a trade name? 0 Y es ~o If "yes". what is the trade name?
PART B. LOCA nON OF GAMES -
7. Address where games, bell jar, or raffle drawing(s) are to be conducted. Lt1 ') ~. 7;) 10 w ~ r · g..-L-~I t-J i ..
8. Name nnd address of authorized games of
chance lessor renting to applicant.
~La
9. Does the applicant own the premises'! r!:f es
o No If "yes". how long'!
10. Capacity for public assembly of premises presently owned or occupied.
:lglt?
11. Have premises been regularly used? 'f/..Yes 0 No If "yes", how long? J l ~ ~
Are games of chance being played now on these premises or has it ever been? Ji(.Yes 0 No If "yes", give full details.
M~ (, l 'J-/J() 1
\ 2. Are the premises or any part thereof
where games of chance are to be played ~es 0 No
licensed by the State Liquor Authority?
If "yes", slate the type of license and number.
--CJ- -DO 0 I Lf - :t-4?;'
13. Has such license ever been If "yes", why? (Ex.plain on a separate sheet, jf necessary, and attach.)
revoked or suspended? 0 Yes ~o
L BJ-GC-2 (Rev. 4/03)
Page lof2
11111111111111111111111111111 .J
~.
I '\~-'
-,
PART C. PURPOSES OF GAMES
14. State the specific pmposes for which the entire net proceeds are to be devoted and in what manner. . 0:>
l 15 Q~8LPJ.. "-l g D(J~~ Oll
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 ofall games of chance shall be devoted exclusively to one or more oftbe "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 ofCbance 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 ofall games of chance in accordance with the terms of the license,
the provisions of the Games ofCbance Licensing Law, the Rules and Regulations oftbe N.Y.S. Racing & Wagering Board and with the provisions
oflocallicensing ordinances or laws.
5. That the mdersigned has read and is familiar with the provisions of the Games ofCbance Licensing Law. 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 oftbe games, except to bookkeepers or accountants for professional services in an amomt not exceeding that fixed by the Board.
IO~/~/@I1]
Date
~~..
Signature of Head of Organization
12 &ceo
Print Name
V/} L E7VTe-
STATE
OF
NEW YORK
}ss
COUNTY
OF
~s>
CITYffOWNNILLAGE OF tv Aff,i..;J ~ F AV-.s
Dec:-o v/J- Lc"'-7VTE being duly sworn deposes and says that (s)he is the person above named,
that s)he has read the foregoing statement 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 d)J ~y of
>'. a~:1JP~
.~ tary Public .
My CoIl}J1iission expires / 13"
/
)1~ , 20--1J..1.
S;gncd ~
/
Commissioner of Deeds
20 Iv
, -
SARA J. DOBBINS
Notary Public, State of New York
Qualified in Dutchess County
Certified in Westchester County
Commission r'~o, 01 D048657~~
Commission Expires '~10'07(j
L BJ-GC-2 (Rev. 3106)
--~- J';Y~';UI/c)
Page 2 of2
1'111."11 .J
I
. GC~2A
I
APPLICATION FOR GA..l\1ES OF CHA.1\lCE LICE..~SE
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ext., Suite 2
Albany, ~. 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.st3te.ny.us
/W/A/P/PI'!Nr<3IE/R/ IE./L/K/SI /LloIDIGIEI2ISI0Igl
:KaIne orOrganization
GC-lli]- 12 /1 ~ - I 61 012/- f;/ 2/ O/1/-;l
NYS Identification Number
GG]/Q]/GQ
Date
,CHEDULE 1:
OFFICERS A.7W DIRECTORS
.is, names. addresses and dates of birth of all offic:rs.
. organization is a corporation, or an incorporated or unincorporated association. list officers and directors.
TITLE NAME DATE OF BIRTH STREET ADDRESS
I 1_1_1_1 I
I 1_1_1_1 I
I 1_1_1_1 I
I 1_1_1_1 ,
I 1_1_1_1 I
I 1_1_1_' I
I 1_1_1_' I
, 1_1_1_1 I
j 1_1_1_1 I
I 1_1_1_1 I
r 1_1_1_1 I
Attach additional sheet if necessary.
CITY
ZIP
I
I
,
I
I
I
I
I
I
I
I
N.L\ME
lVIEMBERS LN CH..J\RGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF
OF BIRTH :ME:MBERSHIP STREET ADDRESS
/ 1 I I
-91 -m 1 1965 I 14 " 134 Anderews Rd
1----; 1 -.;: 1 1930 I 7 I 9 S. View Ln
I 7/ 27 / -1945..1 6
r 7 1 01 1 1936/ 28
/-/-/-/
1__-
I 1 1 I
/-1-1-/
/-1-1-'
CITY
ZIP
;CHEDULE2:
raul Bader
I laGrange
I Hopewell Jet
I
, Wapping!'>!"'; F::lII<::
I W::lppin9~ri: F311e:
I
I
I
I
I
I
12540
~imon Kaufman
12533
Lewis Hakim
tJreg Sarno
11 n::ln::l Plac~
12590
12500
2€l Q~eon /\ARC Ln
~CHEDULE 3: AIJXILIARY/AFFILIATE ORGA....1\iIZATIONS ASSISTING AT GANlES
(MAXIMUM 0:::2 AUXILIARES/.A..kfILLA.. TES EACH AUXLlAR YI At"~L'\n; LISTED MUST HAVE ITS OWN lD l'iUMBEP..)
.
I\A...ME OF AUXILIARY/..<\FFILlA..TE
Gf\J.'vfES OF Cl-LA....NCE ID :NuMBER
I;J-GC-2A (Re". 4/03)
Page 1 0[2
1/1111111111111111111I Ii 11111 -.J
Schedule 1: Officers and Directors
~OO~-~t<9
WAPPINGER LODGE #2609 OFFICERS for 2r-~009
Title
---------------------- --------------- -------------------------- ------------------------------
Name
Address
Exalted Ruler
leading Kgn
loyalKgn
lect. Kgn
Esquire
Chaplain
Inner Guard
Secretary
Treasurer
Tiler
Trustee
Trustee
Trustee
Trustee
Trustee
Joseph P. Havelka Sr.
Eileen E. Boyer
Diana Cole
Paul Bader
Mark H. Fox
Catherine Rohling
Rosemarie Perretta
Robert M. Acquanita
Pamela S. Kultsar
Susan Dorler
James Boyer
Rocco Valente
Alex Czarniecki
Alfred DeRose
Vacant
38 Hickory lane
134 Andrews Road
P.O. Box 549
134 Andrews Road
28 Tiger Road
54 Brothers Road
35 Cathy Road
10 Vorndran Dr.
58 Hillis Terrace
21 Valley Road
134 Andrews Road
61 Fishkill Hook Rd.
31 Helen Drive
25 Hickory lane
No Officer receives compensation of any kind.
Town
Zip
------------------------------ ----------. --------------------
DOB
Pawling
lagrangeville
Hughsonville
lagrangeville
Hopewell Jct.
Wappinger Falls
Poughkeepsie
Wappinger Falls
Poughkeepsie
Wappinger Falls
lagrangeville
Hopewell Jct.
Wappinger Falls
Pawling
12564
12540
12537
12540
12533
12590
12603
12590
12603
12590
12540
12533
12590
12564
11/13/1942
01/02/1943
04/25/1948
09/20/1965
09/15/1957
04122/1940
08/07/1943
OS/25/1942
02/01/1950
03/29/1939
11/28/1937
06/06/1941
10/16/1941
11/28/1961
r'~HEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE o.ft' GAMES
Li3t aU members of appliunt organiDtion and members of autborimf afJilillleS and auxiliary who wiil assist with games. Each person listed must be a
~mhP.!" m ~rpUc~nt ~r.1z.~tion or ~ffi!i1\!~ fur ~t Je."C!...~ ! y~r.
...,
I
YEARS OF
.ME"t-vffiERNM1E DATEOFBIRTH 1\flTh.ffiERSHIP STP...EET ADDRESS
I / , I I
i_l_ _1_1
I , , I I
L S f2-.rz- 'l4ft-k[~~) I
I I I I I
,-,-,-\-,
1-'-'-\
,-,-,- !
i 'r I I
1--'-'--- I
,-'-'-1
i 'r 'r I
,-,-,-,
i 'r 'r I
------j- ,- ,- I
'-'-'-1
! 'r I I
l-'-/~ I
_ J='-'-I
I '-'-I
,-/-,-
1='='=
! I I
-,-,-
:-,=,=
I I
-,-,-
I J
-,-,-
- :-,-
I .
. I
-"~--
! 1
.~____.._.._ I I
I I
1_' _i,_
I f
'-',- ,-
i I
CITY
..-.____c_~__.__._."'." .___ ________~.~__~'__
i
'7TD
.....u.
----~----- --~-"--- --
,
'-_ Rl.Gf'-7A (RM', 3106)
Arlach additional sheet if necessary',
Page 2 of 2
flm.', g"..... Jill. '. nlll. !'-".t'
t~~g~ ~...~:; ::~~"li'J~
g
J
Schedule 4. Assistants to Members in Charge of Games
Years
First MI Last Name Address Town Elk DOB
Frank Abato 39 Kensington Drive Hopewell Jct 11 04/24/1940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 18 05/16/1937
Robert Acquanlta 10 Vorndran Drive Wappingers Falls 22 OS/25/1942
Ralph J. Anzivlna 12 Thorns Lane Highland 22 12121/19~,5
Henry J. Boldrin 28 Gold Road Wappinger Falls 15 01/11/1936
Harold A. Crawford Sr. 318 Sunset Hill East Flshkill 18 02123/1936
Francis J. DeGano 27 Brandy Lane Wappingers Falls 18 07/18/1946
Roger DeJordy 83 Kent Road Wapplngers Falls 18 09/19/1944
Robert Fischetti 91 Ardmore Drive Wapplngers Falls 28 06107/1926
Mark H. Fox 28 Tiger Road Hopewell Jct. 14 09/15/1957
Harris C. . Jones 217 Brothers Road Stormville 18 04/2411944
Robert J. Juliano 2776 West Main Street Wapplngers Falls 13 10/0511953
WIlliam K. Minkowskl 427 McGrath Blvd. Flshklll 28 03/20/1942
Rosemarie Perretta 35 Cathy Road Poughkeepsie 8 09/07/1943
Gregory F. Sarno 13 Dana Place Wapplngers Falls 28 07/01/1936
Kenneth J. Tucker 34 Pawling Lake Pawling 9
Robert N. Wallner 7 Kinry Road Poughkeepsie 19 01/17/1933
,.
GC-2B APPLICATION FOR GAMES OF
NYS RACING & WAC/ERINCl BOAIW CHANCE LICENSE
I WWlcr\'lie:l Ave:. EXl., Suite::2
i\lh'IIIY, NY 12206-166H
'l\'lcpb(lllc (510) 453-o4()() I'u~ (510) 453 tWn
www.ra.:illg.slale.ll.j .IIS
I
*.,
',' , . '41
~
'\:;:-- ~c-#:-, --...
GC-lIJ2l- [][]j] - lliQill- ~
NYS Ldentificallon Number
lol~1 / ~ / lorCll
Dale
SCHEDULE 5 DATES, HOORS AND RENT OF ALL LICENSE PERIODS TO HE HELD
(/'\'01' APPLICABLE FOR BELL JAR GAMES)
,.-. DATE \ HOURS
(9 ~ / 0 l ,! !2!t' , : :1i?~ am @) -
/ .I ,
/ / i
"_",_"'___'~ "-__._-4 1...-.-_''____""'"
/ / ,am/pm -
/ / i am / pm -
~~_-J"'~~~--" .
I Ii: am / pm -
~.__.._.~_...J '-____-' .~__~._...___. .._.__.........~_.__, ~__-'--__'
I I : : am / pm -
"'""__"""-_4 10..-_______" ....-.....-- '--'--..10-..---'
~~ / ~~ / , . ,--,--,' ,am/pm -
I I ' : am / pm -
,"----,,-----, ..---"----' '---"'----" ~_._.......~,.__....... ~-.-~
~~____ I ~~ / ~_~~ I ,am / pm .,"
RENT
, : ,tJ-:bfBJ pm I $ ,
. . , am / pill i $
.:....~am/pm 1$, '
,--~-----," .am / pm 1 $ ~. .
,am/pm i$
,am / pm 1$ , ,
am /pm I $ ~~
am / pm I $
,um / pm : $ ,
am / pill ! $
/ Iii $
,am/pm ", : ,am/pm,
"-_______.-..1 ~~ ~.J.' , , .Ii" . ,
~~ / / : ~_~: ~~ am / pm :. ,---,----,: '..,.-.--0--' am / pm I $
,. .
,am / pITl -
,am / pm -
, ~---'
.. .
RAFFLES
PRIZES (Cash or Fair Market
Vulue of Merchandise)
!$, "
1$.
:$
!$.
!$
DATE
TIME
__~ / / i ~_.~.___": ~_.________ am / pm -
I . / I Ull! / pm -
..._--.. .---" ...._~. , j , --' . l-
I / I -~-- :' am /pm ..
'-----' ~_' ...____~ I .
~------' / / ~ : : am /pm -
I /.~::~-.::==.~~am/pm.
. am / pm
~_-"-----' ~---f
am / pm
,,-~.,
, mn / pm
~~ ~---'
am / pm
, , ,
, am / pm
. _...a.----'
L 1I.)-l;C.26 \Ih,.. 4/0.\1
Puge 1 (Jr:2
IIIIIIIIIU 11111111111111111 ~
,
. · List all of the single types of games to be conducted at all license periods enumerated in Schedule 5.
. '
Note for Veszas Ni2hts and Bazaars only: 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)
\b1.J)--qL -:r {+L I L
JalLe-R- ?Ol~
~ l B- ~ f Y.... W (~l-
For Merchandise Wheels, Bell Jars and Raftles, please complete the appropriate spaces 'below.
MERCHANDISE WHEELS:
INDICATE NUMBER OF
MERCHANDISE WHEELS
(NO LIMIT)
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 TIllS APPLICATION
IS FOR A BELL JAR
liCENSE
YESD NO 0
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BELL JAR DEAL SHALL NOT
EXCEED $3,000 AND NO SlNGLE PRIZE
SHALL EXCEED $500
RAFFLES:
INDICATE IF TIllS APPLICATION
IS FOR A RAFFLE
liCENSE
YESO NO 0
IF YES, liST RAFFLE DATES, TIME(S)
OF DRA WlNG(S) AND PRIZES IN
SCHEDULE 5
THE TOTAL AMOUNT OF PRIZES FOR
ALL THE RAFFLES CONDUCTED DUR-
ING TIllS CALENDAR YEAR SHALL
NOT EXCEED $100,000. NO SINGLE
PRIZE SHALL EXCEED $50,000
EXCEPT lHAT A SINGLE PRIZE OF
$100,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L BJ-GC-2B (Rev. 3186)
Page 2 of2
11111111111 .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 2, 2009
~T appingers Elks #2609
1195 Route 376
~T appingers Falls, NY 12590
Dear Mr. Valente:
Please find the attached "License to Conduct Games of Chance" for
your event to be held on May 1, 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,
10hn C. Masterson
Town Clerk
JCM/cf
SARA J DOBBINS
RICHARD D DOBBINS
6 SCHUELE DRIVE
WAPPINGERS FALL, NY 12590
1000
, J
"" " ,~,' -". . . '-'.', c
H' )'.,1- ,.?~ ~ ..... --.I' .~ i"'~" _;
.>~;:;;:/_/~::/;:~~-~--_. '.
---4_ ...... -~:." ---~"'=\o=-~;;....,.L.'-'-'-~____.<'_ --v--------
r~ Hudson \itd1e~(
Li~~_ Federal Credit Unhit-
~ ...., ..j- .' -'!---'~
----~~~-:-J---';}--:~.-,-~,/
50-7936/2219
02
_,l'~
.. V......i
'.);.. -:. -,
15~ ElAHNEGAT f.C0AD. POUGHKEEPSlE. NY 12bQt 114S-4t.:J.JOl
:~:/i <_~rP~ --U. V
-- "'-'" ;.,....~
I: 2 2 .. 11 711 ~ b ~ I: 0 0 0 000 11 0 50 .. 11 0 0 III .. 0 00
.' ',' IV-
_;::-,:.. ;~-t---;"~