Knights of Columbus
BELL-JAR-GAMES OF CHANCE
WAPPINGERS COUNCIL K OF C 1646
1-108/280
~~~?' d60 ~
b^.11116'1' ;;~ I- /j~t~ /~ 1$1 o? ).?'O !
,~~~ ~ 4~.-t> ~ DOLLARS
/@ ~ WAPPINGE~FALLS ofFICE
....~ MARINE MIDLAND BANK, N,A, M
~, MAIN STREET ~' ,/, -.
WAPPINGERS FALLS, NY 12590 IJ _ '// ~
250
Ii!
I~;
:11
1[
~ HARLAND 1990
FOR
> .: 0 2 BOO . 0 B .': 0 B 2 7 5 5 ~ 2 2111
r
GC-5
--,
NYS RACING & WAGERING BOARD
1 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 0
BELL JAR ~
RAFFLE 0
GC - ~ - [ililiJ- IT[] - ~
N.Y.S. Identification Number
This License Must Be
Conspicuously Displayed
During Conduct of Games
Municipal License Number
The following organization:
$1 2') 00 II
Amount of Fee Paid Lessor's License Number
Address: 2 East Main Street City: Wappinger!': Fl'lll!':
Entire net proceeds to be devoted to the following specific lawful purpose(s):
To be given to various charties.
Names of Members in Charge
James O'Connor
Zip Code:
l?l)q()
John Simons
Max Dao
John Gorman
LICENSE PERIOD
DATE
2009
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
$
EACH GAME (Starting Bank)
NUMBER OF WHEELS
EACH WHEEL
NUMBER OF GAMES
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)
'fnum r.l prk
(Title of Authorized Officer)
(Date)
(Signature of Authorized Officer)
1111 III 11\\\111 11\\ III I III 11\ -I
12/24/2008
L BJ-GC-5 (Rev. 3/06)
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
December 1, 2008
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, New York 12601
Dear Sheriff Anderson:
Enclosed, please find a copy of "Members in Charge" for Knights of Columbus #1646,2
East Main Street, Wappingers Falls, New York, who will be selling BELL JAR Tickets
on their premises throughout the year 2009.
I would appreciate your review ofthe 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,
"
-
I
i
,GC-2
m';; L!\CJf'-JC (;, WAGElZl/'K; HCJARI)
: Walt:rvllcl Ave En., SUIll: 2
Albany, Nj' ] ~2(J(,- J 66F
Tclt:pnulH: (,:,] t;) Lj,';:,.K46U 1'3): (5] g) 45:.-};LjlJ2
Viww.racilll-'.stau.;.ny.w:
I
APPLlCATJOJ\ FOR:
PLEASE CfillCE
GAJvillS OF CHANCED//
HELL JAR 'Q
lZAFFLE D
Fc.m OFFICE
US!: ONLY
errr,?1 ~ : 0 [C
Municipal License Number
I -) z. ()()
$-.f. _). -
Fee;, H.eceivecl
[ IJ 7-1/ lQDJ / [oj 3"1
vatc
INSTRlJCTJONS: PLEASE FILE TlIHEE SIGNED cOJ'ms WITB MUNICIPALITY
GC - ill - [i]J]3J- [ITQ]JJ - '(J I J III ~ Ie I
N.Y.S IdentifIcation Number
IT IS A MISDEMEANOH TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
-r (1,\ ~
I DL;::' ,-.) 01- l/'---"c ff irv 'j e ( (.J Lt tcJ,,-~-s s
'>lamt; of Municipallty \ County
1.
2.
3. Has appli::ant ever been denied l! 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 D
State incorporated
Incorporated Association 0
Unincorporated Association 0
Date [0 / [0 / CD
Date [0 / [0 / CD
Individual
o
State incorporated
5. Did YOlJr corporate status change since your identification number was assigned? 0 Yes 0 No
6. Are you doing business under (J trade name? 0 Yes91No If "yes", what is the trade name?
ART 13. LOCATION OF GAMES
7. Address where games, bell jar, or raffle drawing(s) are to be conducted. ;J. E~:;,+ fl t;.\,..'~,..:; ~-f
8. Name and address of authorized games of
chance lessor renting to applicant.
()0 F (0 Y
I~I /4.
I
C). Does the applicant own tbe premises? 0 Yes 0 No If "yes", how long? Y I'
J O. Capacity for public assembly of premises presently owned or occupied. '3 { 9
J 1. Have premises been regularly used? ~ Yes 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 fun details.
] 2. Are the premises or any part tbereof
where games of chance are to be played
licensed by the Stale Liquor Authority?
] 3. Has such license ever been 0 Yeo "Iii No
revoked or suspended? 0 {
l~rYes 0 No
If "yes", slate tbe type of license and number.
C_L .~~-~Y'3
If "yes", why? (Explain on a separaLe sheel, if necessary, and attach.)
1111111111111111 Hi Ii n 1m II
-~
DART C. PURPOSES OF GAMES
] 4. State the specific purposes for which the entire nel proceeds are to be devoted ancl in what manner.
(~ " V f' -t 0 . l/ ( \~ \ (I '-'- S C h c; f' l -{ ( (" S
I
I swear (or affirm):
1. That ALL the attached Schedules are H material part hereof and are incorporatecl herein as if set out in full in the application. All the answers
containecl 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 definecl in the Gclmes of
Chance Licensing Law ancl the Rules ami Regulations of the Board.
3. That for each license period for which CI license i!: 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 & Wag(:ring
Board and Jocallicensing ordinances or Jaws, will be present at all times, in charge and primarily responsible for the conduct of games.
f. That the undersigned will be responsible for the holding, operation ancl conduct of all gClme!; of chance in accordance with the terms of the Hcense,
the provisions of the Games of Chance Licensing Law, the Rules ancl Regulations of the N.Y .S. Racing & Wagering Board ancl with the provisions
of local licensing ordinances or laws.
Thal the undersignecl has read and is familiar witli the provisions of the Games of Chance Licensing Law as amended, thc Rules ancl Regulations
of the N. Y .5. Racing & Wagering Boarcl, ancl the local licensing ordinances or laws.
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
STATE
~~ /L-
Sig~ure of Head of'Organization
OFf NEW YORK
J o~"- y..J
GOK
r'yL_~V
ill / ~ / [ill]
)ate
Print Name
CITY rrOWNNILLAGE
OF A),f-,f}? liJ(..:::r "5
Hi- a (,
}ss
.bJv-uJo.s
COUNTY
OF
::If) I~ AI /.;' tJl! ~/t-r! being duly sworn deposes and says that (-t)he is the person above named,
mt ~he has read the foregoing statement and the answer therein noted, and that such answers are true and that #)he has personal1y
ffixed his Q.Br) signature to this affidavit.
worn to before me this dIP YJI- day of rJff't/r;t(,,~O\ , 20 (7
Signed
'73; I
/I'lMA..
IU
Notary Public
Commissioner of Deeds
y Commission expires
I,;J, ,2J-r
, 20 /0
BRUCE PISANO
~otar,y:P.ublic,State otNew York
.' ID1PI497.5'l84 Dutchess.Counw
. ;,' 'S,;.iOomniissinn~pines
~~jh~'~;}'o'
I
GC-2A
I
NYS RACING & WAGERING BOARD
1 Watervliet Avt:.. Exl., 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
K fU t c Vl 4- .s
Name of Organization
GC- ill - [2Iili] - [ilQ[JJ -I oIzLd :( 1 Q I
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 N,6JVIE DATE OF BIR!H STREET ADDRESS r CITY ZIP
L" ,"'-: ,u.c~ ~~ l'I...fJ1- \J' (:) ('0 u.:>,.j I ~ 1 .2::- 1 .{:. y I {)... S- .Msv , '..s Ii oe I ,~,,~.f.. II a.C:.~) ,
'f (,,^,_~ 1''' '. \1 h, \"M 1/ . ~ 1-3<- *-J -1L 1 ~ I 1 6' s I ne 1"1../",," t R--l 1 r~,w ,{!. I I:z. b6S
~"~CA;'d,loK I) I k.:,I't' I '(JI.)' I~I ~/XLI)',/ $. fY/<"s,...c. 1~ I W~[lvf( NLtS I 12.S'(O
1!<'6e>€ Del<. I /1"\, I<s: ~{" I / Y 131 III 3}1 4"/ - ;I,J(der(fl.rp.~ ~ ' I 12k_C:~
Ue~~" I;.t 11.1 n,,-i' ~1 <t", I~I 3..LI ~I ~ i)""r'R (,,,-eo 1~'1 CJ!( 11 u ~,b
IMi "7 (Sed !3 ~.' c'" .' ""'" 10 I ~ 1 ..E1. 1 6' I 1 ':.' i-k. I,,, v.. k~ ~ II 2 -C'i' ZJ
I}/)/',.., C,."/:€. 111:,o..;:~ L Y'" b 1-2.;-'--01 60 Ilf /I.,,, s,< '" IU,I ~ _ , 1 I ':" ~.-6
-rr" <./,. "-' I J~ ^~ r.;oiJ r"" 1.13,.1 '" <-/ b D 16~ S ft"; ,<.e, ~",I 0-'Jt~111 <J q~
t/~[,t.s t--eE I Cl ~"L. uL.1,f"L~1 12-1 '?>zl/v Sh-e~/'('<;loc>of ~I~ ~.I ) "Lcr-ct.-6
I 1_1_1_1' I I
I 1_1_/_1 1 I
UJL] / I~I bl 1 101 ~
Date
Attach additional sheet if necessary.
~CHEDULE 2: ME:MBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF
NAMJ2: . OF BIRTH :MEMBERSHIP STREET ADDRESS CITY. ZIP
J'M"e(~"'MnfI-1LI 2)-/~~11 25'1/-; '5-+. 1 L.O'llf~~ 1 IZ:>~
..\.,~"" '>~fJ/.f"",I--.lI:M.I ~31 ,e; 1 it> ~ ~ \1-" 1 lP'ti' ~ I I U~(j
~~lv" S, M 0 r~ & 1 -1L 1 .lL 1 .5,~ I 2-1 I,f ( I eL I ~-" '" 1 La (' (:=;t(, I, >.S''i~
~ Lti~ Do.. 6 I m.3..L 1 (C, 3J);:;:;. I 2 VW 'f /C R. Ik-I uJ ~tt ~~ I /2S'it)
, I 1 1 I I '1 I
1=1=/=1 I I I
1_1_/_1 I I I
I 1 / I I 1 I
1=1=/=1 I I I
~CHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 A UXTI...IARIESI AFFILlA TES. EACH AUXTI...lAR Y I AFFlLIA TE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXlLIARY/AFFillATE
GAMES OF CHANCE ill NUMBER
11\ 1111111111111\ \\11\ 1111111 ~
n.1-GC-2A (Rev. 4/03)
Page 1 of 2
r SCHEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE OF GAMES I
List 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 organization or affiliate for at least] year.
'YEARS OF
MEMBER NAME . DATE OF BIRTH MEMBERSHIP STREET ADDRESS
I 1 1 I 1
1-1-1-1-'
/-1-1- 1- 1
/-1-1- I = I
'-1-1-1 I
1-1-1-1 = I
1-1-1-1 _ I
/-1-1- 1_ 1
1-1-1-'_1
1=1=1= I _ I
1_1_1_1_1
1_1_1_1_1
1_1_1_1_1
1_1_1_1_1
I 1 1 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_1_1_1
1_1_1_1_1
1_1_1_1_1
1_1_1_1_1
I 1 1 I_I
1=1=1= _ I
I 1 1 _I
'=1=1= 1 _ 1
1_1_1_1_1
I 1 1 I_I
1=1=1= I _ I
1_1_1_1_1
1_1_1_1_1
1_1_1_1_1
BJ-GC-2A (Rev. 4/03)
Attach additional sheet if necessary.
Page 2 of 2
CITY ZIP
1 I
I I
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I 1
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.1 1
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11111111111111111111111111111 -.J
--,
GC-2B APPLICATION FOR GAMES OF
NYS RACING & WAGERING BOARD CHANCE LICENSE
I Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
GC- [ill- ~ - [[gJJ - ~
NYS Identification Number
[1]]/~/~
Date
SCHEDULE 5 DATES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPLICABLE FOR BELL JAR. GAMES)
DATE HOURS RENT
, I , ,I I am / pm - ,am/pm! $.
. , , i' . ~ " I " .
,I . ' / . I ,am / pm - ,am/pm! $.
, . .' . " . ,',
,I , , / . I am /pm - ,am/pm! $.
. . .' . , " . " .
,I . , / . I am / pm - ,am/pm! $.
, , . .' , , " I ,- .
, I . .1 I am / pm - ,am/pm! $.
. . . . . . , i . . . I . .
, I , ,/ . I am / pm - ,am/pm! $.
. , .' , , . . , ,', ,
./. , I . I am / pm - ,am/pm! $.
, . .' . , " . .' .
, I . , I , I ,am / pm - ,am/pm! $.
, . I . . " . I' .
,I . . I . I am / pm - .am/pm ! $.
, . . . . , . . . ,',
,I . , I . I ,am / pm - am / pm !$.
, , . . . ' . . , " ,
./, ' I . I am / pm - am / pm !$.
, , I . . , . . I , " .
,I . , I , I am / pm - ,am/pm! $.
~ , . .' , . . . , ,',
RAFFLES PRIZES (Cash or Fair Market
DATE TIME
I Value of Merchandise)
.1 .1 am / pm - am / pm ,$. . . . , ,', .
. I . . . . , " .
, I . .1 I am / pm - am/pm !$~.
. I . I . . , I' . , ,',
.1 ,I I am / pm - am / pm 1$.
I . I . i . . . . . . . , ,'.
,I . .1 I am / pm - am / pm !$.
. I I . . . . . . . . . ,- .
~ / . / . I am / pm - ,am / pm !$.
:= . I . J . l 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 STATE ZIP
BJ-GC-2B (Rev. 4/03)
Page 1 of 2
1111111111111111111111\111111 ~
-
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 Vef;!as Nif;!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)
LIST THE MAXIMUM AMOUNT OF PRIZES
TO BE A WARDED FOR EACH TYPE OF
GAME OF CHANCE (GAME BANK)
at $
at $
at $
at $
at $
For Merchandise Wheels, Bell Jars and Raffles, 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 THIS APPLICATION
IS FOR A BELL JAR
LICENSE
YES~ 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:
INDICA TE IF THIS APPLICATION
IS FOR A RAFFLE
LICENSE
YESD NO 0
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 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 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L BJ-GC-2B (Rev. 4/03)
Page 2 of2
11111111111 1111111 11111111111 -.J
,'"'
~
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
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
GEGJ- ~
Municipal License Number
GC - [ili] - lliG
N.Y.S. Identification Number
Wappinger
Name of Municipality
ral Municipal Law, the following findings and determinations
~ DNo
Falls. NY 12SQO
After investigation, and a hearing if required under Sec. 19
have been made:
1. All the members-in-charge designated in the
character and have never been convicted 0
Signature of Person Conducting Investigati
ames of chance are of good moral
Title
2. Applicant is a qualified authorized organization as defined in the Games of Chance Licensing Law.
3. All the members designated in the application to conduct games are bona fide active members of the applicant
organization.
4. The premises presently owned or occupied by the applicant are in every respect adequate and suitable for
conducting games of chance.
5. The games of chance are to be conducted in accordance with the provisions of the Games of Chance Licensing
Law, the Rules and Regulations of the N.Y.S. Racing and Wagering Board, and local ordinances.
6. The entire net proceeds are to be devoted exclusively to one ore more of the "lawful purposes" as defined in the
Games of Chance Licensing Law and the Rules and Regulations of the N.Y.S. Racing and Wagering Board.
7. There is satisfactory proof that no commission, salary, compensation, reward or recompense wiIl 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)
XJ Yes DNa
:j9 Yes DNo
~Yes DNo
l!J Yes DNa
KJ Yes DNa
~Yes DNa
KJ Yes DNa
:j9 Yes DNa
DYes DNa
TO BE COMPLETED BY MUNICIPAL CLERK: /
As a result of the findings and determinations stated above, license is GRANTED l!! license'
Signature of
Filing date of Application December 01, 200R Authorized Officer
Date ~()'V Title Town Cler
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< o<~. 4103) 1111111101111111111111111111 .-J.