Wappinger Elks Lodge (6)
r
GC-5
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCElQ9
BELL JAR 0
RAFFLE 0
GC - [i]iJ- CiliIiJ- GIQill- GLIQLLJ
N.Y.S. Identification Number
--,
NYS RACING & WAGERING BOARD
I Broadway Center. Suite 600
Schenectady. NY 12305-2553
Telephone (5]8) 395-5400 Fax (518) 347-]469
www.racing.statc.ny.us
'.,'_:::f;"'':- ,
]'
-f::-
~
This License Must Be
Conspicuously Displayed
During Conduct of Games
Municipal License Number
The following organization:
$/ ?'1 00 /1
Amount of Fee Paid Lessor's License Number
Address: 1195 Route 376. City: Wap~:dn~ers Fans
Entire net proceeds to be devoted to the following specific lawful purpose(s):
Zip Code: 1 ?'i90
Names of Members in Charge
Paul Bader
Simon Kaufman
Lewis Hakim
r,'-Pg ~::lm()
LICENSE PERIOD
DATE
DAY OF WEEK
HOURS
TYFE(S) OF GAMES
01 1M; I ?009
RAFFLE DRA WING
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
$
NUMBER OF GAMES
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
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 Town of Wappinger
(Name of Municipality)
(Date)
r.lp,-k
(Title of Authorized Officer)
Oc I
(Signature of Authorized Officer)
11111111111111111111I11111111 .J
02/25/09
L BJ-GC-5 (Re\'. 3/06)
r
GC-4
NYS RACING & WAGERING BOARD
] W!ltervliet Ave. Ext., Suite 2
Albany, NY 12206-] 668
Telephone (5] 8) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
--,
GC - [ili] - GLLJ - Will- ~
N.Y.S. Identification Number Municipal License Number
Town of Wappinger
Name of Municipality
1195 Route 376, WappingersFalls, NY 12590
Address .
Municipal Law, the following findings and determinations
of chance are of good moral ~ es 0 No
After investigation, and a hearing if required under Sec. 192 of the Gen
have been made:
1. All the members-in-charge designated in the
character and have never been convicted
Signature of Person Conducting Investigati n'
~:S hef I -ff
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 Garnes
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 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)
10 Yes DNa
1rI Yes DNo
Kl Yes DNa
~Yes DNa
KI Yes DNo
~Yes DNo
IKI Yes DNa
IXl Yes DNa
DYes DNa
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED Ii' license is DENIED 0
Signature of
Filing date of Application 2/10/09 Authorized Officer
Date M 19-or)1 Title Town Clerk of Wappinger
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 mev.4/03) 1111111111111111111111111I111. --1
r
GC-2A
I
APPLICATION FOR GAMES OF CHANCE LICENSE
NYS RACING & WAGERING BOARD
] Watervliet Ave. EXL., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
~IGIE~
Name ot'Organization .
GC- [ili] - ~ - [M@ - [QGIQ[1W
NYS Identification Number
,CBEDULE 1: OFFICERS AND DIRECTORS
,1St names, addresses and dates of birth of all officers.
. organization is a corporation, or an incorporated or unincorporated association, list officers and directors.
TITLE NAME DATE OF BIRTH STREET ADDRESS
1_1_1_' I
1_1_1_1 I
1_1_1_' I
1_1_1_1 I
1_1_1_' I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_' I
Attach additional sheet if necessary.
GG]/Q]/[J]
Date
CITY
ZIP
I
I
I
I
I
"'1
I
I
I
I
I
.;.
:CHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF
NAME OF BIRTH MEMBERSHIP STREET ADDRESS CITY ZIP
faul Bader 1_1_1_1 I I
I 91 20 1 1965 I 14 1 134 Anderews Rd I laGrange 12540
~jmon Kaufman ,--; I--W- I~I 7 I 9 S. View Ln I Hopewell Jet 12533
\.ewis Hakim I 71 27 1 ~I 6 I 26 Ql,I88A MAC 1FI I Wappingp-f!': F::>II" 12590
Greg Sarno I 7 1 01 1 19361 28 I 1 ~ n::>n<> PlaC9 I \^'9ppir:lg9r~ Fallt 125~O
'=1=1=1 I I
1_1_1_1 I I
1_1_1_1 I I
1_1_1_1 I I
;CHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF2 AUXILIARIES/AFFILIATES. EACH AUXILIARY/AFFILIATE LISTED MUST HAVE ITS OWN JD NUMBER.)
NPJvffi OF AUXILIARY/AFFILIATE
GAMES OF CHANCE ID NUMBER
11\ 1111111111111\ II 1111111111 --3
nJ-GC-2A (Rey. 4/03)
Page 1 of2
-,
I
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ext.. Suile 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
GC-2
FOR OFFICE
USE ONLY
I DO
$ 'if5-
Fees Received
lQJIj / 10 ~ / [Q]3]
Dale
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC-rn-m-~~
N.Y.S. Identification Number
IT IS A MISDEM~~OR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
~OlV .v 0 F WA- V YlLJa-~vt.. 't)~~->
Name of Municipality County
2.
3.
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
Date @]]J / ffi / [fl1J
Dote[I]/[I]/[I]
5. Did your corporate status change since your identification ~~r was assigned? 0 Yes ~o
6. Are you lJoing business under a trade name? 0 Yes ~o If..yes....what is the trade name?
PARTB. LOCATION OF GAMES
7. Address where games, bell jar, or raffle drawing(s) are to be conducted. I { ~ 5 Rr. ~ '7 ~ tv Prr r. ~ \-J:'\..
\
Incorporated Association ~
Unincorporated Association 0
State incorporated
\J~uJ if)R.~
State incorporated
Individual
o
8. Name and address of authorized games of
chance lessor renting to applicant.
tJ[A-
9. Does the applicant own the premises'! ~es 0 No If"yes", how long'!
I O. Capacity for public assembly of premises presently owned or occupied.
11. Have premises been regularly used? 11lYes 0 No If "yes", llowlong? J.-U ~~
Are games of chance being played now on these premises or has it ever been? t& Yes 0 No If "yes". give full details.
\-leV, " !).-~O 8
12. Are lhe premises or any part thereof
where games of chance are to be played ~es 0 No
licensed by the State Liquor Authority?
1.gf,
If "yes". state the type of license and number.
CL.. -(joO 14 -).. '-1:3
13. Has such license ever been
revoked or suspended? 0 Yes
~o
If "yes", why? (Explain on a separate sheet. if necessary. and attach.)
L BJ-GC-2 (Key. 41tl3)
Page I of2
111111~lnl~1111 ...J
r I
PART C. PURPOSES OF GAMES
14. State the specific purposes for which the entire net proceeds are to be devoted and in what manner.. . L
l 15 qJ-M<. rt8-8t....rz,,.. "-{ g ofl2.R.aIT1 OIJ2
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 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 conduet 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
oflocallicensing ordinances or laws.
5. That the undersigned has read and is familiar with the provisions of the Games ofCbance 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.
lol?-I/~/[Q]iJ jlt'~~~
Date Signature of Head of Organization
~t'((:? ~ Uf?PV7F
Print Name
STATE
OF
NEW YORK
}ss
COUNTY
OF
~s~
CITyrrOWNNILLAGE
OF
12~ {)O 10~ L.- L N oil. being duly sworn deposes and says that (s)he is the person above named,
that (s)he 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 bef~ me this t) ~ day of
x:i~4~i0-tP4
Notary Public
'-.-.
My Commission expires
~JJ.
, 20 ~) '7'
'\ ."
Signed. V -.- k7D1{ '-Giv
V
Commissionec of Deeds
f..~o
,20~
~ARA J. DOBBINS
Notary Public, State of New York
Qualified in Dutchess County
Ga'1wlission ~o. 01 D04865}1.:30~~'I'()
,r,;',sion Expires ~
--
Jr!3v/UJ/v
L B.J-GC-2 (Rev. 3106)
Page 2 of2
1111'."11 -1
I
. 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
APPLICATION FOR GAMES OF CHANCE LICENSE
Name of Organization
GC-lli] - [ilill- [1Qli] - [Q]M1Q
NYS Identification Number
~CHEDULE 1: OmCERS AND DIRECTORS
.ist names, addresses and dates of birth of all officers.
f organization is a cOIporation, or an incoIporated or unincoIporated association, list officers and directors.
TITLE NAME DATE OF BIRTH STREET ADDRESS
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 I
1_1_1_1 1
Attach additional sheet if necessary.
GG]/[J]/c;I;]
Date
CITY
ZIP
I
I
I
I
I
'I
I
I
I
I
I
SCHEDULE 2: MEl\1BERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF
NAME OF BIRTH MEMBERSHIP STREET ADDRESS CITY ZIP
Paul Bader 1_1_1_1 I I
I 91 20 1 1965 I 14 I 134Anderews Rd I laGrange 12540
Simon Kaufman l---a/ffi I~I 7 I 9 S. View Ln I Hopewell Jet 12533
Lewis Hakim I 7/~/~1 6 1 28" QY88R }!,ARe l.n I Wappil1gFlN:. F~lIc: 1 ::z.sgQ
Greg Sarno I 7 1 01 1 19361 28 I 1 ~ n~n~ pl~Qi I W~ppiRg9~ Falls 12599
1=1=1=1 1 I
1_1_1_1 I I
1_1_1_1 I I
1_1_1_' I I
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 AUXILIARIES! AFFILIATES. EACH AUXILIARY! AFFILIATE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXILIARY/AFFIUATE
GAMES OF CHANCE ID NUMBER
1111111\\111\1111 \lUlll \111\ ~
_ DJ-GC2A (Rev. 4/03)
Page 10f2
Schedule 1: Officers and Directors
WAPPINGER LODGE #2609 OFFICERS for 2008-2009
Title Name Address Town Zip DOB
.-.-..---------------- --------------- ------------------------- - ------------------------------ ----------------------------.- -
Exaltf:ld RIder Rocco Valente 61 Fishkill Hook Rd. Hopewell Jct. 12533 06/06/1941
Leading Kgn Mark H. Fox 28 Tiger Road Hopewell Jct. 12533 09/15/1957
LoyalKgn Eileen E. Boyer 134 Andrews Road Lagrangeville 12540 01/02/1943
Lect. Kgn Vacant
Esquire Anthony M. Storzieri 26 Cobey Terr. Poughkeepsie 12601 07/07/1936
Chaplain Catherine Rohling 54 Brothers Road Wappinger Falls 12590 04/22/1940
Inner Guard Vacant
Secretary Robert M. Acquanita 10 Vorndran Dr. Wappinger Falls 12590 OS/25/1942
Treasurer Pamela S. Kultsar 58 Hillis Terrace Poughkeepsie 12603 02/01/1950
Tiler Susan Dorler 21 Valley Road Wappinger Falls 12590 03/29/1939
Trustee James Boyer 134 Andrews Road Lagrangeville 12540 11/28/1937
Trustee Salvatore Filippone 13 Ravine Road Hyde Park 12538 07/17/1931
Trustee Dana Mills Pawling Lake Box 17 .. Pawling 12564 02/18/1971
Trustee Joseph W. McDowell 127 Innis Ave. Poughkeepsie 12601 04/21/1941
Trustee Vacant
No Officer receives compensation of any kind.
r SCHEDULE 4: ASSISTANTS TO MEMBERS IN (."HARGE 0:(4' GAMES
List aU members of applicant organi2ation and membeB of autborized affiliates IIIld auxiliary who will assist with pmes. Each person listed must be a
~mhP.r ~ ~!,plie1tnt iM!}~ni~tien or l1ffi!i~t~ fur ~! !e.-<t~ ! y~r.
..,
I
YEARS OF
MB-"ffiER NA...\fE DATE OF BIRTH ~1&"mERSHIP STREET ADDRESS
! I , I '
1__- _I
I , , I I
c... S f2...rz- ,- ~t~~ ) I
I I I I I
,-,-,- i - i
1-'-'-1 I
1__- I
I , I I I
i 'r I I I
1-'-'--1 I
1-'-'-1 I
I 'r -r I I
1-'-'-' I
I 'r 'r .
___.~_.' I
\-'-'-1
1-'-'-'
I 'r , I
1-'-'-1
_--'=,-,- I
I '-'-I
1-'-'--
,-,-,-
------'/-- ,--
-,- i-
:-,-,-
! '----/-'---- ,----
,------..--.---'..-..... -,-,-
I I
-,-,-
- ,- ,-
I I
_/_1_
1 {
I J
I !
_i _,_
I ;
- ,-,-
j I
I
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CITY
!
-"- ----.. . "._^--- i -------- ---..~~-~---------
,
______" __~c
!
!
~ Rf.r.r -J!. ro..... 3ill6)
Auacn addii:ionai sheet if necessary'.
Page 2 nf2
!m,," Q'" 11ft, sm"m,
I'fllth /'1(11" ,
....!J~~J. ".!li~ ~~!I~
.-_. ~ --. .._~_.. - ,,~.~, -...-.... ..
'7TD
....0.
,
.J
stants to Members in Charge of Games
Years
Last Name Address Town Elk DOB
lto 39 Kensington Drive Hopewell Jct 11 0412411940 . .
late 6 Hackensack Hghts Rd Wapplngers Falls 18 05/16/1937
~uanlta 10 Vorndran Drive Wapplngers Falls 22 OS/25/1942
tivlna 12 Thorns Lane Highland 22 12121/19~.5
drln 28 Gold Road Wappinger Falls 15 01/11/1936
Iwford Sr. 318 Sunset Hill East Flshklll 18 02123/1936
3ano 27 Brandy Lane Wapplngers Falls 18 07/18/1946
Jordy 83 Kent Road Wapplngers Falls 18 09/19/1944
chetti 91 Ardmore Drive Wapplngers Falls 28 06107/1926
( 28 Tiger Road Hopewell Jct. 14 09/15/1957
les 217 Brothers Road Stormvllle 18 0412411944
iano 2776 West Main Street Wapplngers Falls 13 10/05/1953
JNwiski 427 McGrath Blvd. Flshklll 28 03/20/1942
" .tltUa 35 Cathy Road Poughkeepsie 8 09/07/1943
roo 13 Dana Place Wapplngers Falls 28 07/01/1936
cker 34 Pawling Lake Pawling 9
IlIner 7 Kinry Road Poughkeepsie 19 01/17/1933
I'
GC-2B API~LICATION !i'OR GAMES OF.
N'r'S J{ACING &. WM,ERIN(] HOARD CHANCE LICENSE
I WiJlt:r"lit:l .'!,vt:. EXl., Suile 2
Allntll)', NY t220(/-lo611
'I\'lcphollt: (Sill) 453-114tlO Fux (5111) 453H4lJ2
www.radng.slalt:.ny.lIs
I
I~~~
Name of Organization
GC- [ill- [2lillJ - []ili - ~
NYS ldentilicalion Number
lli]/rn/[illl
Date
SCHEDULE 5 DATES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(lVOT A PPUCABLE FOR BELL JAR GAMES)
DATE · HOURS
O'7)/f)(P/~i ,:.'1~~m@.
/. . ,/, . ,'. ,am / pm -
/ / i am / pm -
...-..---- ---~ '---..----...... .
/ / ,am /pm -
'----4--~ /, , ,/ ,-----,! , , ' .am / pm -
~~___~ / ~_~ / __.~_~! ~..........-o: ~-,---,am 'pm -
___ / ~~ f' am/pm -
~~ /. . . / . , ' .am 'pm -
/ / ' ' am / pm -
_--J _~ ~---' "'---__....0.---' . ____~
~~ / f I am /prn _.~,.
'__'__-" / f .
~~f /
RENT
,: ,l).;t.o~m ~ $ .
am / pm ! $
.am/pm!$ ,
am / pm ~ $
am / pm ~ $
.arn/pm '$ ,
.am /pm 1$ .
am / pm ~ $
.am/pm!$,
am / pm ! $
,am/pm !$.
am/pm i$.
"
I-'
,
. .
. '---~
1-'
,. .
. . "---~
am/pm.~ .'
, . , .J. ' . , .
, am / pm ~. .
. . ~---' ,--~..
RAFFUI.:S
__I /
~~/ ~~f .! .
/ f I~~,
-~ ~~:~~.
./ , . / ~----! ~--:,
/ .f. .:._ "---,"
.am /pm -
am / pm -
.am /pm -
,am/pm -
,am /pm -
"
.am , pm
,am /pm
}1m / pm
am / pm
,
am / pm
PRIZES (Cash or Fair Markel
Value of Merchandisd
!$. .".
!$.
:$
!$.
!$
DATE
TIME
.-,
.'
"
"
SCHEDULE 6 EXPENSES
List items of expense to ~e incurred, and the names and addresses of persons LO be paid.
ITEM OF EXPENSE VENDOR NAME STREET ADDRESS C1TY STATE
~l~&- l4~1~~AtJ~ ~R~~,u()f) ~f!JOt- t-n{
L{~&(1..c.,\~PA9d-~ ~ ll<!fff;"1,IL. ~r~lh-rl
ZIP
l~s?, ~
\~()
L IlJ-Gl'-16 (Rev. 4/0.\)
f'ag~ I of 2
111111111111111111111111111 ~
rSCHEnULE 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 V.as Nie:bts 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)
(bLt}-qL -:rf+LIL
:r CJ IL-z.. 'r- ? 0 l~
~ \ B- ~r)( Wl~l--
For Merchandise Wheels, Bell Jars and Raflles, 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 SINGLE PRIZE
SHALL EXCEED $500
RAFFLES:
INDICATE IF TIllS APPLICATION
IS FOR A RAFFLE
LICENSE
YESD 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 THAT A SINGLE PRIZE OF
$100,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L BJ-GC-%B (Bev. 3186)
Page 2 of2
11111111111 -.J
TOWN OF WAPPINGER
,OWN 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
February 9, 2009
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, NY 12601
Dear Sheriff Anderson:
Enclosed, please find a copy of the members of the Wappinger Elks #2609,
Route 376, Town of Wappinger, who will be conducting Games of Chance
on March 6th, 2009.
I would appreciate your review of the "Members in Charge" listed on the application.
Please complete the "Findings and Detennination" form attached and return the form
to our office.
Thank you for your attention to this request and your prompt reply.
Y ours truly,
Ene.
BALANCE DUE
~ CASH
o CHECK
o M.O.
AMOUNT OF ACCOUNT
THIS PAYMENT