Wappinger Elks Lodge 2609
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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 & Charitable 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)
1/95 37f, C-JhlIJ/Nt'rll
Street Address Municipality
Address Where Games are Conducted. if Different:
l/
f'Al.IS /.2~'9d
Zip
()tJ 7C~IESS
County
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[ill jPrifiJ / [QR] County ~
Date of License Period Hours of License Period
Admissions (if fee is charged)............................................................................. $
Profit or Loss from games other than Merchandise Wheels................................ $
~~~ ~;~ :~ ~e~~~~:~ ~::~~h~)................................................. $
$
4. Total Receipts (Add Items 1,2 and 3)................................................................
B. EXPENDITURES - (Show only payments actually made)
Describe Expenditure Payee
Check No.
1. Rent
2. License Fee
3. Games of Chance Equipment
and Supplies
s,/ K./Ju. f'H'*rI
1~7
4. Services
11~ ACtfqA~/T~ 132..
5. Other Expenses 811ft J../Gtrl sA
6. Total Expenditures........ ..... ................ ............. ...... ....... ..................... ....... ..... ....... $
C. NET PROFIT OR (LOSS) $
1. Profit or (Loss) Before Additional License Fee (Item A41ess Item B6)...............
2. Additional License Fee (UST CHECK NUMBER )..................... $
3. Net Profit or (Loss) (Item I less Item 2)............................................................... $
D. GAME BANK FUND Payee Check No. Amount
(Memo Entry Only) LOfll's A-Illo ~1r)' /3j 7"0. O()
E. DISPOSmON OF AND ACCOUNTING FOR NET PROCEEDS -
I. If this is organization's first license period. give opening balance, if any. in the $
Special Gmnes of Chance Account.......................................................................
Source of opening balance $
2. Unexpended balance of net proceeds shown on last report..................................
L BJ-GC-7 (Rev. 4103) Page 1 on
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3. Net profit 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 ccount............ $
Explanation (I..",k "~'II,'t( (;JlII"'~ - " Jo
6. Total net proceeds (add Items 1 through 5).......................................................... $
Disbursements of net proceeds since last report: (Attach additional sheets if necessary)
=i= Check No. DescriDtion of Disbursements Name & Address of Pavee
7 ID 1$ 9 €.~s HATJ",.,J4l rOllN/"n,,,,
7 10 /35" }.IyS. EHPLlt-ItIIiT MYI'-S
7/t" 1.3 {, RI! ~/A"7 L,~" FIll''' ({'.(,u~~ l eNe,"""
( .2 3
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Amount
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~............ ................ $ I Il. 4/ / .1 8' I s-I
......................... $ :l. .3 :L 'I .0t]
7. Total Disbursements.................. ..................................................
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)
DepositoI}' Name of Bank Account No. Reconciled Balance
1) Checking 13~1{ k (} P )/. y. (, B () / II 8 tf 1/3 ,,~ 302 </. S'1
2) Savings
3) Other
Total (Must be the same as Line E8 - Unexpended Balance)............................... $
Instructions: This section must be fully completed by aU parties.
I swear, or affirm tbat the information and statements contained herein have been examined by me and to the best or my
knowledge and bellei' are true, correct and complete.
K.tLLT.s~
Last Name
5'8 II, Lll,s TIfA). foUl; ~J.6t'ISIE 1.2.'''J
ST~) ~ - ~\.~~~dL;./l;-
Phone Number Signature
Member in Charge:
.5 110 JI
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County
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Date
tAU/'I1P
Last Name
'1 :30,,7H '111ft.) L"'. 110 hW6LL .:::TeT. /';.5"33 /Jure), ES.s
(~) ~ - ~ ~;~ l~ ""--1/10 rim /0fJ
Phone Number Signature Date
Pre er (if different):
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10 L/D.c~IJj2.4" (J i.. t.J191/1"'~A MaS 1:JS''1o /)() 7Chrj~
(00ill) GlliIZl- ~ ttr Zf:!t [lli] ihEJ / [ill]
PhOllC Number Signature Date
L BJ~.7(Rev.4I03) Page 20f2 IIIIIIIIHIII ..J
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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.rdCing.state.ny.us
-,
CASH CONTROL REPORT
GAMES OF CHANCE
Organization: Wj:)I/'N "~ G/J:s 0 5e ::J't:I~ LD. No.: -,:) - ~ - 020/..3 Date of License Period: () 7 0 7 6 C
.. ..--
Type of Game Type of Game Type of Game Type of Game Type of Game CONTROL SUMMARY
No. 1 1J1Nk ~cl:. No. 2 ..::JOpl. ~~( No.3 f)1, S,')( No.4 No.5 PROFIT OR (LOSS)
Number of Number of Number of Number of Number of (A) - ( ICJ~. 00)
Locations " Locations I Locations I Locations Locations Game No. 1
Starting Starting Starting Starting Starting (B) - ~J. 0 ()
Game No.2
Bank Po. I> 0 Bank /00. 0 (1 Bank If/o.oo Bank Bank
--...-....--.- ----_.~- - --_..._~_..- (C) -
Ending Ending Ending Ending Ending Game No.3 8'1.00
Bank 3 '18." 0 Bank 15'1.00 Bank / g Cj . 0 0 Bank Bank
(D) -
Profit or ) Profit or Profit or Profit or Profit or Game No.4 -
(Loss) (lo;1.0(} (Loss) 5'1.00 (Loss) 89.00 (Loss) (Loss)
- (E)-
(A) (B) (C) (D) (E) -
ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY Game No.5
WORKERS WORKERS WORKERS WORKERS WORKERS
Net Profit 1/
( SEe 177i 9-,1, ~d l'&T) or (Loss) 38." 0
(Enter on Line A-2 of GC-7)
......--...
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L BJ-GC.7B (Rev. 4103)
Page 1 of2
Prepared By
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r MERCHANDISE WHEELS I.
Merchandise Wheel No. 1 Merchandise Wheel No.5 Merchandise Wheel No.9 CONTROLSU RY
Receipts (Less change bank) PROFIT (LOSS)
Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded-~-- Less: Value of Mdse. Awarded (A) - M
o. 1
Profit or (Loss) - Mdse.
(A) Profit or (Loss) (E) Profit or (Loss) Wheel No.2
I (C) - Mdse.
Wheel No.3
Merchandise Wheel No.2 Merchandise Wheel No.6 (D) - Mdse.
Wheel No.4
Receipts (Less change bank) Receipts (Less change bank) (E) - Mdse.
Wheel No.5
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded (F) - Mdse.
Wheel No.6
Profit or (Loss) (B) . Profit or (Loss) (F) (J) (G) - Mdse.
I Wheel No.7
i
(H) - Mdse.
Merchandise Wheel No.3 Merchandise Wheel No. 7 Merchandise Wheel No. 11 Wheel No.8
(I) - Mdse.
Receipts (Less change bank) Receipts (Less change bank) Wheel No.9
(J) - Mdse.
Less: Value of Mdse. Awarded Less: Value of Mdse. A warded Wheel No. 10
(K) - Mdse.
Profit or (Loss) Profit or (Loss) Wheel No. 11
(C) (G) (K) (L) - Mdse.
Wheel No. 12
Merchandise Wheel No.4 Merchandise Wheel No. 12
Receipts (Less change bank) Receipts (Less change bank) Net Profit
or (Loss)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
(Enter on Line A-3 of GC-7)
Profit or (Loss) Profit or (Loss)
~ M ~
OFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
Page 2 of 2
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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 9 04/24/1940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 16 05/16/1937
Ralph J. Anzivlna 12 Thorns Lane Highland 19 12/21/1935
Henry J. Boldrin 28 Gold Road Wappinger Falls 13 01/11/1936
Harold A. Crawford Sr. 318 Sunset Hill East Fishkill 16 02/23/1936
Francis J. DeGano 27 Brandy Lane Wappingers Falls 16 07/18/1946
Roger DeJordy 83 Kent Road Wapplngers Falls 16 09/19/1944
Richard O. Desruisseau 183 Red Cardinal Court Poughkeepsie 19 11/05/1936
Richard D. Dobbins 6 Schuele Drive Wappingers Falls 20 05/30/1949
Stephen F. Drobnak 53 Moccasin View Rd. Fis h kill 7 02/02/1957
Robert Fischetti 91 Ardmore Drive Wappingers Falls 26 06/07/1926
Mark H. Fox 28 Tiger Road Hopewell Jct. 12 09/15/1957
Harris C. Jones 217 Brothers Road Stormville 16 04/24/1944
Robert J. Juliano 2776 West Main Street Wappingers Falls 11 10/0511953
Joseph Jurina 173 Hillside Lake Rd. Wappinger Falls 8 02/28/1963
William K. Minkowski 427 McGrath Blvd. Fishkill 26 03/20/1942
Eugene P. Pampalone 53 Helen Drive Wapplngers Falls 18 09/03/1936
Rosemarie Perretta 35 Cathy Road Poughkeepsie 6 09/07/1943
Gregory F. Sarno 13 Dana Place Wapplngers Falls 26 07/01/1936
Kenneth J. Tucker 34 Pawling Lake Pawling 7 03/19/2029
Robert N. Wallner 7 Kinry Road Poughkeepsie 17 01/17/1933