Wappingers Elks Lodge 2609 (5)
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GC-7 FINANCIAL STATEMENT
NYSRACING&WAGERINGBOARD OF GAMES OF CHANCE
] WatervlietAve. Ext., Suite 2 OPERATIONS
Albany, NY ]2206-]668
Telephone (5]8) 453-8460 Fax (5]8) 453-8492 (Please Print or Type)
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, ] Watervliet Ave. Ext., Suite 2. Albany, NY ] 2206-] 668,
and retain one copy for your files. Where applicable, one copy shall also be submitted to the Chief Fiscal Officer of the County.
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Date of License Period
Number of Players
A. RECEIPTS-
1. Admissions (if fee is charged)............................................................................. $
2. Profit or Loss from games other than Merchandise Wheels................................ $
3. ~~~ ~~:~ ~e::~;~ ~::~~h~)................................................. $
$
4. Total Receipts (Add Items 1, 2 and 3)................................................................
B. EXPENDITURES - (Show only payments actually made)
Describe Expenditure Payee
Check No.
$
$
$
$
$
$
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 13 I )..................... $
3. Net Profit or (Loss) (Item 1 less Item 2)............................................................... $
D. GAME BANK FUND Payee Check No. Amount
(Memo Entry Only) LoUiS )}fi7'cL:.lT,' /025" 70el "c
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 GllJIleS 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 of2
1. Rent
}~1
2. License Fee
3. Games of Chance Equipment
and Supplies
57 K~IJFt1fHJ
4. Services
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5. Other Expenses
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Hours of License Period
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/ 0 0 5
0
J 0 0 ~
.10101
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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 hearing account(s)............ $
5. Other deposits into or adjustments in Special Games of Chance Account............ $
Explanation
6. Total net proceeds (add Items 1 through 5)..............................................,........... $
Disbursements of net proceeds since last report: (Attach additional sheets if necessary)
Date Check No. Description of Disbursements Name & Address of Pavee
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0
0
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Amount
~..... ... ............. ..... $ D . [QIQJ
........................... $ 3 G- O &, .[I[i]
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)
Depositorv Name of Bank Account No. Reconciled Balance
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1) Checking
2)
3)
Savings
Other
Total (Must be the same as Line E8 - Unexpended Balance)............................... $
Instructions: This section must be fully completed by aU parties.
I swear, or aftinn that the information and statements contained herein have been examined by me and to the best of my
knowledge and belief are trne, correct and complete.
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L Bl-GC.7 (Rev. 4103)
Page 2 of2
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GC.78
NYS RACING & WAGERING BOARD
I Watervliet Ave, Bx!.. Suite 2
Albany. NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.ntcing.state.ny.us
Organization: l../AffJfl/Gfl- /ilkS krdve J(p() 1
CASH CONTROL REPORT
GAMES OF CHANCE
-,
I.D. No.: /3 - ;l/Cf - (POJ.. - cI)D13 Date of License Period.[Q]IJ / ~ / ~
- .. ,..~.....
Type of Game Type of Game Type of Game Type of Game Type of Game CONTROL SUMMARY
No. 1 ~lJu t.) {}-C k.. No.2 .../ oW 1"l;;L No.3 11/ ~ t;;,1 X No.4 No.5 PROFIT OR (LOSS)
Number of <6" Number of Number of Number of Number of (A) - IIlJ:2.00
Locations Locations I Locations I Locations Locations Game No. 1
Starting Starting Starting Starting (B) - j'SLj, () L'
Starting Game No.2
Bank S-OO. Ot,' Bank /Ot.? . Oc- Bank /O().OO Bank Bank
~-----------_._.- (C) -
Ending Ending t.J Ending G Ending Ending Game No.3 /;2c/, uO
Bank I} J.;JJ," 0 Bank ;L). (., ~ Bank ),} It ,,() Bank Bank (D) -
Profit or Profi t or Profit or Profit or Profit or Game No.4 -
(Loss) 7 ~2 I()O (Loss) J5L{,tJ() I (Loss) / ,;1.1.l'0 (Loss) (Loss) (E)-
(A) (B) (C) (D) (E) --
Game No.5
ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
WORKERS WORKERS WORKERS WORKERS WORKERS
L, ~ T ) Net Profit /I /J 0 oS'; ,J 0
( 5~1i /J 7T,ItC j, l j or (Loss)
(Enter on Line A-2 of GC-7)
-_._----_._,~--_._.._,..,.._-~-,,-- ----"
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L BJ.GC.7B (Rev. 4103)
Page 10f2
Prepared By
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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. Anzivina 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 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. Fishkill 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 10/05/1953
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 Wappingers 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
r MERCHANDISE WHEELS
Merchandise Wheel No. 1 Merchandise Wheel No.5 Merchandise Wheel No.9
Receipts (Less change bank) Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded ~~~~ Less: Value of Mdse. Awarded
Profit or (Loss) (A) Profit or (Loss) (E) 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) (J)
Merchandise Wheel No.3 Merchandise Wheel No.7 Merchandise Wheel No. 11
Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
Profit or (Loss) (C) (0) Profit or (Loss) (K)
Merchandise Wheel No.4 Merchandise Wheel No.8 Merchandise Wheel No. 12
Receipts (Less change bank) Receipts (Less change bank)
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded
CONTROL S RY
PRO (LOSS)
(A) - se.
el 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
Profit or (Loss) Profit or (Loss)
~ ~ ~
R PROFIT OR (LOSS) FOR EACH TYPE OF OAME ON CORRESPONDING LINE OF CONTROL SUMMARY
L BJoGe-7B (Rev. 4/03) Page 2 of 2
Net Profit
or (Loss)
(Enter on Line A-3 of GC-7)
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50-235552
WAPPINGERS LODGE #2609 BPOE OF THE USA INC. 2i9
P.O. BOX 47 6801484113 j,
WAPPINGERS FALLS, NY 12590 DATE c;UZ/ h
131
PAY TO THE 7'\ ~ or' e-/?PC" ,,-
ORDER OF t/VI f ' ......
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$ 1-17- ~
CD ~n~f:~::~~:~
DOLLARS
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I: 0 2 * Ii 0 2 :i 5 21: 1/1 baD * '-t a '-t * * :i 1/1 0 * :i .
BANKOF
~vv 48V~~,Rood
YORK Poughkeepsie, NY 12603
MEMO
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