Wappingers Elks Lodge 2609 (4)
r
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
INSTRUcnONS: 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. Ellt-, 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
OPERA nONS
(Please Print or Type)
lJ AfJl'l"'6('!l~
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Zip
{Jl/70~.s
County
Street Address
Zip County
[lli]/~/~ {;,
Date of License Period Hours of License Period
Admissions (if fee is charged).............................................................................
Profit or Loss from games other than Merchandise Wheels................................
Profit or Loss from Merchandise Wheels............................................................
(Form GC-7B must be completed and attached)
4. Total Receipts (Add Items 1. 2 and 3)................................................................
B. EXPENDITURES - (Show only payments actually made)
Describe Expenditure Payee Check No.
o
:l 'I
s,/ t" fI flf/W
,
It.JCf
$
$
$
$
$
$
0
0
.3 (,
~ /
( ~ :L
0
{ .3 .2
o.@:@]
OlS .0I]
. [Qill
. [iliJ
.0QJ
.m
.(g0
.~)
. @TI]
.~)
1. Rent
2. License Fee
3. Games of Chance Equipment
and Supplies
4. Services
5. Other Expenses /J61~ J.."6HSI! t8Di hctiUJtIlIT/J 1'1(,
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) R,ehA,..d fJo hb/M.$ 1l.J~ 700.00
E. DlSPOSmON OF AND ACCOUNTING FOR NET PROCEEDS -
I. If this is organization's first license period, give opening balance, if any, in the $
Special Games of Chance Account.......................................................................
Source of opening balance $
2. Unexpended balance of net proceeds shown on last report..................................
L BJ-GC.7 (Rev. 4103) Page I of 2
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0
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Amount
7. Total Disbursements............................................................................................ $~. ~
8. Unexpended balance of net proceeds (Item 6 less Item 7)................................... $ ~.l1Jj]
(Include interest bearing accounts)
F. Reconciliation of Unexpended Balance (To be Completed Monthly - - Upon receipt of Monthly Bank Statement)
De,positol)' Name of Bank Account No. Reconciled Balance
1) Checking IJhNK.. of /.1. y. ~8o/l/e 'I/}3 J~ ;l.S-1. t/'1
2)
3)
Savings
Other
Total (Must be the same as Line E8 - Unexpended Balance)............................... $
InstructiOl.: This section must be fuBy completed by aU parties.
I swear, or affirm that the information and statements contained herein have been examined by me and to the best of my
knowledge and belief are troe, correct and complete.
.[ID}
IJv7Ch IfSs
County
m/rn/.~
Date
L8SI Name
J c> .t1 ;e. W ~t'!1t t:. 'Il /A Us
Street AddKSS City
(~)rmJ-~
Phone Number
L BJ-GC.7 (Re\',4I03)
/.J C/ 1C~!!;,
County
CL:G / [M / 0IJ
Date
Page 2 of2
IIUIIIIIINII ..J
I.D.No.: 1.:1 -:2/ , -'o2..-O;1.t1}3 Date ofUcense Period: / 6 / ff] / rn
CONTROL SUMMARY
PROFIT OR (LOSS)
(A) - / )
Game No.1 <..;}6'. ~o
r
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.racing.state.ny.us
Organization: wIJfPNce!t €LJc.s irJ jse 1tdCf
CASH CONTROL REPORT
GAMES OF CHANCE
Type oj Game
No. 18LAct~1<.
Type of Game Type of Game
No.2 ::](;l~1I. Io~ No.3 giG S/'X
Type of Game
No.4
Type of Game
No.5
Number of
Locations .,_~~
Number of
Locations..L-
Number of
Locations
Number of
Locations
Number of
Locations
/
Starting
Bank SoC, () fI
Starting
Bank / ()() · 00
--.--..---...-
Starting /bO,Oo Starting Starting
Bank Bank Bank
Ending 1.l8.0d Ending Ending
Bank Bank Bank
Ending "
Bank '/70 , 0 C
Ending
Bank / / (, · CJ 0
Profit or ( )
Profit or
Profit or
Profit or
Profit or
(Loss) ;;J.S" . t7(1 (Loss) /t..oo (Loss) 3B.oc (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
{ S €I{ 1..,& T ') ....---.- .. -" -- - --..-...-
ftlJ ~c hI(/')
."
-----
L BJ-GC.7B (Rev. 4103)
Page 1 of2
(B) -
Game No.2
(C) -
Game No.3
(D) -
Game No.4
(E) -
Game No.5
-,
1(,,00
38.00
Net Profit
or (Loss) ~ I. 0 0
(Enter on Line A-2 of GC-7)
f()~ 4,L1 /iClfC</fN/719
Prepared By
~HUlII'I~I'ml .J
r
Merchandise Wheel No. 1
Receipts (Less change bank)
Less: Value of Mdse. Awarded
Profit or (Loss)
Merchandise Wheel No.2
Receipts (Less change bank)
Less: Value of Mdse. Awarded
Profit or (Loss)
Merchandise Wheel No.3
Receipts (Less change bank)
Less: Value of Mdse. Awarded
Profit or (Loss)
Merchandise Wheel No.4
(A)
(B)
(C)
MERCHANDISE WHEELS
Merchandise Wheel No.5
Merchandise Wheel No.9
CONTROL SU RY
PROFIT (LOSS)
(J)
(A) -
W 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
Receipts (Less change bank)
Receipts (Less change bank)
(K)
Net Profit
i or (Loss)
(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
Less: Value of Mdse. Awarded
Less: Value of Mdse. A warded
Profit or (Loss)
Profit or (Loss)
(E)
Merchandise Wheel No.6
Receipts (Less change bank)
Less: Value of Mdse. Awarded
Profit or (Loss)
(F)
Merchandise Wheel No.7
Merchandise Wheel No. 11
Receipts (Less change bank)
Less: Value of Mdse. Awarded.
(G)
Profit or (Loss)
Merchandise Wheel No. 12
Receipts (Less change bank)
Receipts (Less change bank)
Less: Value of Mdse. Awarded
Less: Value of Mdse. Awarded
Page 2 of 2
IIIIIIIIIIIUI ..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 04/2411940
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. 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. Fishklll 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 04/2411944
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. Mlnkowski 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