Wappingers Elks lodge 2609 (2)
.
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 6t\ 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 $50.55 made payable to the D. C.
Finance Commissioner from the Wappinger Elks Lodge #2609, Town of Wappinger,
for an "additional license fee" for Games of Chance activity that took place on
8/04/06 and 9/08/06 respectively.
C}2c~
i,if ohn C. Masterson
Town Clerk
Town of Wappinger
"
r
GC-7
NYS RACING & WAGERING BOARD
I Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telcpbonc (518) 453-8460 Fax (518) 453-8492
www.racing.stare.ny.us
INSTRUCTIONS: Prepare report in triplicate. Within 1.!!!n after each license period, send original to clerk of municipality, send one copy to
N.Y.S. Racing & Wagering Board, Bureau of Bell Jar & Charitable Gaming Compliance, 1 Watervliet Ave. Ex!., Suite 2, Albany. NY 12206-1668,
and retain one copy for your files. Where applicable. one copy shall also be submitted to the Oaief Fiscal Officer of the County.
FINANCIAL STATEMENT
OF GAMES OF CHANCE
OPERA nONS
(Please Print or Type)
-,
/IQS- 37(, WIJP'IWG~A. FALl$
Street Address Municipality
Address Where Games are Conducted, if Different:
/;ZS1o
Zip
() C/nA~s.s
County
Street Address
Zip County
3 [illJ/rn/~ ,
Date of License Period Hours of License Period
Admissions (if fee is charged)............................................................................. $
Profit or Loss from games other than Men::handise Wheels................................ $
~~~ ~~~ ::: ~e:~;~~ ~ee~~~~)................................................. $
4. Total Receipts (Add Items 1,2 and 3)................................................................ $
B. EXPENDITURES - (Show only payments actually made)
Describe Expenditure Payee
0
I 0 7 :l
0
/ 0 7 :l
. [ili]
.0EJ
.0EJ
.~
Check No.
131
$
$
$
$
$
$
0
0
3 (p
~ I
/ 0 I I
5 0
I I ~ 01
o .IQJQ]
:l S"' . [E]QJ
.@E]
.m
.~
. IT]
.~
.~
.1 s-I.s' I
. lIE]
I. Rent
2. License Fee
3. Games of Chance Equipment
and Supplies
6 Y ~vFI1I1"
,
J:J.7
4. Services
5. Other Expenses IJUR. /...1 C 1141 (
13t1h Ac q IIlf.Nrlt
6. Total Expenditures............... ..... .......................... ................................ ... .............. $
C. NET PROFIT OR (LOSS) $
I. Profit or (Loss) Before Additional license Fee (Item A4 less Item B6)...............
2. Additional License Fee (UST CHECK NUMBER / tf 8 )..................... $
3. Net Profit or (Loss) (Item I less Item 2)............................................................... $
D. GAME BANK FUND Payee Check No. Amount
(MemoEnu-yOnly) Idc~"f4J I.)f)Lbl14.S /'11 ~()o, t!1(J
E. DISPOSITION OF AND ACCOUNTING FOR NET PROCEEDS -
1. If this is organization's first license period. give opening balance, jf any, in the $
Special GaJDeS of Chance Account.......................................................................
Soun::e of opening balance $
2. Unexpended balance of net proceeds shown on last report..................................
LBJ-GC.7fRev.4IOJ) Page I of2
o.[QIQJ
j :L 5" S .llliJ
IIIIIII1III ..J
j J
r
I
'f (, () ./'1 15"1
o.~
.~)
2) Sav iogs
:)) Orher
'T'J.,,_"~1:::.11 r~..~I~._", 1-~ ...L_ -'-m- -- T :_- 1"':'0 Un.....r___..I_~ n~J~_......, $1
v~ \i"lU~;. iJ\.: un;- t~""t iC ~ LillI; ~o - '{ c~"-ilCuUCU H41 i.lU,",C)~a~...n.."UH.....q.....n
I /lc2/11 /I.[ill]
Instructions: This ~tion must be fuDy Completed by all parties.
I swear, or affirm that the information and statements (."Onwined herein have been examined by me and to the best of my
knowledge and belief are true, correct and compiete.
Head of Organization:
Ifl1311'11 t IJ..I~ I
FirstN~ Mllll". 76;eL. Last!oarr;8ht~rjJ~/i! /c;J.t.c3
~8~i5';' i!L' (,l~; 1513' ~i~~ .~ /'1 /// I.Pi
(I 17 L...J j i I I i-I i 10 10 I~::t~b ;:1-/:u/ tS~
Phone Number Sigl'.alu
Member in Charft:
i 51 / 111 i 0 i ~ i i,fJ~.J~1 f' II( 1,4 I H I
Pilst Name Last Name
'1 SO(J71{ I/,JlW IN. ~ ~w~LL :::J;:7;
Street Address City Cl.......
( 181 ~151 ) I ~i;;tJ (,1-1s17i31 / I ~l'
Phone Number Signature
Pren~rer fif different):
i-fro i~ IL i RiTi
hrst Name
I/(I u..1 L I[L~J~ 11<1
IJ (J TChES$,
Countv
i / i A! "'3 10 ji " II "" I". I
! Iv!!l I , ,'"'lV)
Date
/.25':13
f),iTCh€S5
County
'/' ~l/l ~IO I/IAI/l
I !vl/i~i i/[Vi"'l
VaL:
Cc--..
,
i
/0 IJ;;M de",..,. Ill?"
Street Address City
( L"L2'J.ft ) I~J~17 I - I ~ 191.2.1l{ I
Pltone Number
i~ j <:.J~.l~ I Fll# II IT 1/71
Last Name
I>> Ll.s
.-,~. ~. r'" - .-~, . r,.,\",
L-. j).."'vii,~.",.f l,.f"~l'~ ~;UJJ
l' U,!:;-C: i.. Vi .k
()v7CJ~s.s
CounlY
I /1 ~ i / tr i~ i i I 0 l~ i
Dare
~lII!1inlllHmll ..J
Organization: LJI}PPINCE~ cLts [u Jse ~D' 1.0. No.: /3 -,;lICJ -to2.., - 02"13 Date of License Period:~ / ~ / rn
Type of Game Type of Game Type of yame Type of Game Type of Game CONTROL SUMMARY
No.1 8l.i1clc:{iJ.e/C. No.2 :::rtJUIl ~hIt No.3 81t: Sly No.4 No.5 PROFIT OR (LOSS)
Number of I Number of Number of Number of Number of (A) -
Locations ._~_ Locations___L Locations I Locations Locations Game No. 1
r
GC-7B
CASH CONTROL REPORT
GAMES OF CHANCE
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ex!., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
Starting
Bank .soO. 00
Starting
Bank loo.C/o
Starting
Bank /00.00
Ending
Bank I 7' . 0 0
Profit or 7(,
Starting Starting
Bank Bank
Ending Ending
Bank Bank
Profit or Profit or
Ending
Bank /3 foB .0(7
J
Profit or 8 (. 8
Ending
Bank ;1.2.8, CI 0
Profit or
!.
(Loss) .00 (Loss) 'e2. 8. "0 (Loss) .00 (Loss) (Loss)
(A) (B) (C) (D) (E)
ENTER PROm OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
WORKERS WORKERS WORKERS WORKERS WORKERS
L/.$7 ') .....__.......___.__"'......__...~._.___m..___
( 5 1Z-1l. If~ ?tc/'~J
- ~
..
-~----
L BJ-GC.7B (Rev. 4/03)
Page I of2
,.'
3"'8.00
(B) - 1c.28.00
Game No.2
(C) - 7~ .OG
Game No.3
(D) - -
Game No.4
(E) - -
Game No.5
Net Profit /I/, 0 Z" 0
or (Loss) 7t) IX . 0
(Enter on Line A-2 of GC-7)
106J(~J /Jc f(,(4#.1ITI9
Prepared By
~IIBII~IIII ..J
r
MERCHANDISE WHEELS
Merchandise Wheel No. 1
Merchandise Wheel No.5
Receipts (Less change bank:)
Receipts (Less change bank:)
Less: Value of Mdse. A warded
Less: Value of Mdse. Awarded
Profit or (Loss)
(A)
Profit or (Loss)
Merchandise Wheel No.2
Merchandise Wheel No.6
Receipts (Less change bank:)
Receipts (Less change bank:)
Less: Value of Mdse. Awarded
Less: Value of Mdse. Awarded
Profit or (Loss)
(B)
Profit or (Loss)
Merchandise Wheel No.3
Merchandise Wheel No.7
Receipts (Less change bank:)
Less: Value of Mdse. Awarded
Profit or (Loss)
(C)
Merchandise Wheel No.4
erchandise Wheel No. 8
Receipts (Less change bank:)
Less: Value of Mdse. 5rded
Less: Value of Mdlie. Awarded
Merchandise Wheel No.9
Receipts (Less change bank)
Less: Value of Mdse. Awarded
(E)
Profit or (Loss)
(J)
e.
No.1
- Mdse.
Wheel No.2
(C) - Mdse.
Wheel No.3
(D) - Mdse.
Wheel No.4
(E) - Mdse.
Wheel No.5
(F) - Mdse.
Wheel No.6
(G) - Mdse.
Wheel No. 7
(H) - Mdse.
Wheel No.8
(I) - Mdse.
Wheel No.9
(J) - Mdse.
Wheel No. 10
(K) - Mdse.
Wheel No. 11
(L) - Mdse.
- Wheel No. 12
(F)
Merchandise Wheel No. 11
Receipts (Less change bank:)
Less: Value of Mdse. Awarded
(G)
Profit or (Loss)
(K)
Net Profit
i or (Loss)
I
(Enter on Line A-3 of GC-7)
Profit or (Loss) Profit or (Loss)
~ ~ ~
om OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
BJ-GC-7B (Rev. 4/03)
Merchandise Wheel No. 12
Receipts (Less change bank:)
Less: Value of Mdse. Awarded
Page 2 of2
11111111111111 .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 12121/1935
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. 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 09/15/1957
Harris C. Jones 217 Brothers Road Stormville 16 04/24/1944
Robert J. Juliano 2776 West Main Street Wappingers Falls 11 10/05/1953
Joseph Jurina 173 Hillside lake Rd. Wappinger Falls 8 02128/1963
William K. Minkowski 427 McGrath Blvd. Fishklll 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 Wappingers 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
l
.
I
~
, 1",,1,',,1 " ". i 50-235552" " l'
1\ WAPP:,'NGERS LODGE #2609 BPOE OF THE USA INC. 2i9 14 8 ,
I~ P,O, BOX 47 6801484113 I
WAPPINGERS FALLS, NY 12590 '6'
", ~ DATE ac:-T, 3 0 J"'" \
!~ I'
I : ~~J'ici~'7)u TCIfi!.1>!ii " ()hr>afl ce ~'J's,oNe,L- I $\5&, -IT !
I ,~ rr~~ ~,' 'I {)..-cr- DOLLARS {D =7,/..,,~1 \ I
[0 .,,7' ,,,."'""~,.,
Ii mrffi' I'
I~ 1llD I
li~ BANKOF !
I:I~ NEW 48 Va,," Road JJ ~In I,'
Ii "YORK Poughke'psi"NY 12603 jV6'U :
II ~~~2~f;fcff,~t: "'~O'~8~..11~-OI~tJ~"=" I
II ~ I