Wappingers Elks Lodge 2609
r
GC-7
NYS RACING & WAGERING BOARD
I 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 ~ 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, ] Watervliet Ave. EXL, Suile 2, Albany, NY 12206-1668,
and retain one copy for your files. Where applicable, onc copy shall also be submitted to the Chief Fiscal Officer of the County.
FINANCIAL STATEMENT
OF GAMES OF CHANCE
OPERATIONS
(Please Print or Type)
W~fJfINd(1I MLt.s
-,
/.2510
Zip
tJvTtA~~!'
County
Zip County
[ill] / [ill] / [ill] (,
Date of License Period Hours of License Period
Admissions (if fee is charged)............................................................................. $
Profit or Loss from games other than Merchandise Wheels................................ $
~:. ~~~:~ ::~~~~:~ ':::::t~~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 S7 ~lJlJrNhN 1~7
3. Games of Chance Equipment
and Supplies
4. Services
5. Other Expenses
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 / J{7 )..................... $
3. Net Profit or (Loss) (Item 1 less Item 2)............................................................... $
D. GAME BANK FUND Payee Check No. Amount
(Memo Entry Only) A.~fJlt. ftri To J.,." rr; /38 700. CI 0
E. DISPOSmON OF AND ACCOUNTING FOR NET PROCEEDS -
l. If this is organization's first license period. give opening balance, if any, in the $
Special GanteS 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 of 2
0
I .3 If 7
0
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$
$
$
$
$
$
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.110
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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 inlere.'1l bearing account(s)............ $
5. Otber deposits into or adjustments in Special Games of Chance Account............ $
Explanation (311-"t sUtAr.( CJ/llut 7/1/
,
I :J is 5
( :l I
--,
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.m)
6. Total net proceeds (add Items 1 through 5).......................................................... $
Disbursements of net proceeds since last report: (Attach additional sheets if necessary)
_or!: Check No. Descriotion of Disbursemenls Name & Address of Pavee
~ 137 flteotlH7",,,r SIlvIUS. Tt1,., /)tllss~L
Amount
3fJD.Dt1
......................... $ 3 0 0 .~
......................... $ .3 <2- S 8 .l1NJ
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)
De,pository Name of Bank Account No. Reconciled Balance
1) Checking I!,,,.II Ie.. "F iI,/, , 80 I '-/8 1.(1/3 .J :3)'2. 5"6 I t'q
2) Savings
3) Otber
Total (Must be the same as Line E8 - Unexpended Balance)............................... $
Instructions: This section must be fuDy completed by all parties.
I swear. or affinn that the infOl'lllfttion and statements contained herein have been examined by me and to the best of my
knowledge and belief are true, correct and complete.
tJo1ChlS"S
County
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Date
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Street Address City
(~) 1~lo1l{,l- 01IillJ
l't1one Number
Pre arer (if dift'erent):
t2 () L fl.
First Name
/6 V d~"& dJl/Ul () ~.
Street Address City
(~)~-~
Phone Number
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County
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Date
L BJ.GC., (Rev. 41ll3)
Page 2 of2
IIRUIIIIIIII ..J
Organization: W A'l'ltJ~eA ~L'~ __ltJ_~e. ~,~, I.D. No.: /3 - & - ~c.2.. - q;].d/1 Date of License Period:~ / 10 I'll / ~
Type of ~ Type of Game Type of Game Type of Game Type of Game CONTROL SUMMARY
No. 1 j), J: :::r~ k. No. 2:J0/~A. AhA No.3 .Alt: SIX No.4 No.5 PROFIT OR (LOSS)
Number of Number of Number of Number of Number of (A) - r If). 6(}
Locations 8 Locations I Locations I Locations Locations Game No. 1
Starting Starting Starting Starting (B) - / t,3.oo
Starting Game No.2
Bank_5p~._~()_ Bank /O(J . Pt) Bank / f)(j. () 0 Bank Bank
(C) - ,2 /'1.00
Ending Ending Ending r.;. Ending Ending Game No.3
Bank IY70.o 0 Bank /263.f) 0 Bank 31. o(J Bank Bank.
J (D) -
Profit or Profit or Profit or Profit or Profit or Game No.4 -
(Loss) "0.0 ~ (Loss) 163 . t1 (J (Loss) tll'/. Of) (Loss) (Loss)
(A) (B) (C) (D) (E) (E)- -
ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY Game No.5
WORKERS WORKERS WORKERS WORKERS I WORKERS
I
!
cj JI.5/) i Net Profit .I~3cj7.oo
(SL IE. A JJJfc}, or (Loss)
-v (Enter on Line A-2 of GC-7)
............ _.,,"----.~~-
fJ€IlJ AcfQI9N//))
r
GC- 7B
NYS RACING & WAGERING BOARD
I 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
~
L BJ.GC-7B (Rev. 4103)
Page 1 of2
I
Prepared By
~HIIII~~~III~I .J
r MERCHANDISE WHEELS
Merchandise Wheel No. I Merchandise Wheel No.5 Merchandise Wheel No.9 CONTROLSU RY
Receipts (Less change bank.) Receipts (Less change bank) Receipts (Less change bank) PROFIT 0 LOSS)
Less: Value of Mdse. A warded Less: Value of Mdse. Awarded----- Less: Value of Mdse. Awarded (A) - M
W o. 1
Profit or (Loss) Profit or (Loss) - Mdse.
(A) (E) Profit or (Loss) heel No. 2
(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) (1) (G) - Mdse.
I
i Wheel No.7
(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. Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
(Enter on Line A-3 of GC-7)
Profit or (Loss) Profit or (Loss)
~ ~ ~
OFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
Page 2 of 2
II I 111111 ~ IUIIIIIII .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 9 04/24/1940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 16 05/16/1937
Ralph J. Anzivina 12 Thorns Lane Highland 19 12/21/1935
Henry J. Boldrln 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 Wappingers Falls 16 09/19/1944
Richard O. Desrulsseau 183 Red Cardinal Court Poughkeepsie 19 11/0511936
Richard D. Dobbins 6 Schuele Drive Wappingers Falls 20 05/30/1949
Stephen F. Drobnak 53 Moccasin View Rd. Fish kill 7 02/0211957
Robert Fischetti 91 Ardmore Drive Wapplngers Falls 26 06/07/1926
Mark H. Fox 28 Tiger Road Hopewell Jct. 12 09/1511957
Harris C. Jones 217 Brothers Road Stormville 16 04/2411944
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. Mlnkowskl 427 McGrath Blvd. Flshklll 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
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WAPPINGERSLODGE #2609 BPOE OF THE USA INC. 50;1~35552
P.O. BOX 47 6801484113 I
WAPPINGERS FALLS, NY 12590 OCt:. -20 t:J /
DATE w ",l.) '=='
147
M'
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
ROBERT L. VALDATI
November 6th, 2006
Dutchess County Commissioner of Finance
22 Market Street
Poughkeepsie, New York 12601
Subject:
ADD'L. LICENSE FEE - GAMES OF CHANCE
Enclosed are checks in the amount of $66.10 and $50.55 made payable to the D. C.
Finance Commissioner from the Wappinger Elks Lodge #2609, Town of Wappinger,
for an "additional license fee" for Games of Chance activity that took place on
8/04/06 and 9/08/06 respectively.
Qa-c~
{,{John C. Masterson
Town Clerk
Town of Wappinger