Wappingers Elks Lodge 2609 (6)
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
June 14,2006
Dutchess County Commissioner of Finance
22 Market Street
Poughkeepsie, New York 12601
Subject: Additional License Fees - Games of Chance
Dear Sir:
Enclosed are three checks made payable to the Dutchess County Finance Commissioner
from the Wappinger Elks Lodge #2609, Town of Wappinger. As indicated on their
financial statement for Games of Chance Operations, the Additional License Fee is for
G.O.c. activity that took place on the following dates:
12/02/2005
04/07/2006
05/05/2006
$34.95
$51.25
$54.05
No additional license fee for G.O.c. activity that took place on 03/03/2006.
Line item C-2 on their financial statement for that date indicates $0.00.
Sincerely,
QQCJ4~
6~ c. Mas~::~ ~
Town Clerk
smk
Ene. (3 checks)
I I
GC-7 FINANCIAL STATEMENT
NYS RACING & WAGERING BOARD OF GAMES OF CHANCE
1 Warervliet Ave. Ext., Suite 2 OPERA TIONS
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492 (Please Print or Type)
www.racing.state.ny.us
INSTRUCTIONS: Prepare report in triplicate. Within 7 dayS after each license period, send original to clerk of municipality, send one copy to
N.Y.S. Racing & Wagering Board, Bureau ofBell Jar & Charitable Gaming Compliance, ] Watervliet Ave. Ext, Suite 2, Albany, NY 12206-1668,
and retain one copy for your files. Where applicable, one copy shall also be submitted to the Chief Fiscal Officer of the County.
.
LJ(j PI/JJ(;J:/.. rAllS /)5"9("
Zip
IJ,I' 'Tc)JF~'$'
County
Number of Types of Games
Zip County
3 [ilij/~/~
Date of License Period
t
Street Address
Number of Players
A RECEIPTS-
1. Admissions (if fee is charged).............................................................................
2. Profit or Loss from games other than Merchandise Wheels................................
3. Profit or Loss from Merchandise Wheels............................................................
(Form GC-7B must be completed and attached)
Hours of License Period
4. Total Receipts (Add Items 1. 2 and 3)................................................................
B. EXPENDITURES - (Show only payments actually made)
Describe Expenditure Payee Check No.
2. License Fee
3. Games of Chance Equipment
and Supplies
s'i MllfHflIJ
/
/J7
$
$
$
$
$
$
r 0
I .:2 S"
. [QIQ]
.@E]
. [QIQ]
. [Q]QJ
. [QIQ]
. IT]
. [Q@]
. [QIQ]
.16~1
.[10
1. Rent
/3), J)c4,lIlJioIJJA
/.:23
0
0
:3 ~
(p j
i 0 8 I
- if
~
/ () ;L It
4. Services
5. Other Expenses IJbli/1 4Cl'N.Sl
6. Total Expenditures............. ....................... ................... ............. ....... ...... .............. $
C. NET PROFIT OR (LOSS) $
1. Profit or (Loss) Before Additional License Fee (Item A4 less Item B6)...............
2. Additional License Fee (UST CHECK NUMBER )..................... $
3. Net Profit or (Loss) (Item l1ess Item 2)............................................................... $
D. GAME BANK FUND . Payee Check No. Amount
(Memo Entry Only) k(/iJ /)..rJTg l.ciTl' I/). " 70t:l, C t'
E. DISPOSmON OF AND ACCOUNTING FOR NET PROCEEDS -
1. 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 (ReT.4/03) Page 1 of 2
.[33
I iJJ 8 .3 .I~ Ii./ I
11111111111111111111111 .-J
WAPPINGERS LODGE #2609 BPOE OF THE USA INC. 502-1~35552
PO BOX 47 6801484113
WAPPINGERS FALLS, NY 12590 DA TE t:: /; 2.-1 c..
130
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. ITHE
IW\TKOF
~~'\l 4f! Vassar Road
YORK Poughkeepsie, NY 12603
$ SY- OJ-
DOLLARS ~
~tjill~/f,-
MEMO /_.=_..-._~
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0
0
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.1010 I
I"Tl'Q1
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Amount
F.
1)
2) Savings
3) Other
Total (Must be the same as Line E8 - Unexpended Balance)............................... $
Instructions: This section must be fully completed by all parties.
I swear, or affirm tbat the information and statements contained herein bave been examined by me and to tbe best of my
knowledge and belief are true, correct and complete.
(Ji'Tchl~5
County
[ill]/rn/toltl
Date
:l:l 9 ~jJl#5(lu lntiL LJJ4PI/JJoOl MILS /.2fYtJ
-.-, c.y ~ Q ~
l!ti!~) ~ - [lli[illJ Sign /'U, 'Wt:-
Pre er (if different):
o(j/iIlT
First Name
/ () L0 p.l dj/H/ ~,e. lA/A-II/Neff!.. ;7JLIS j;2S-9()
Street Address City ~ T {> Zip..l
(~)~-~ . .v U~
Phone Nwnber Signature /
L BJ-GC-7 (Rev. 4103) Page 2 of2
j)" Ichk S:5
County
~/I/ l.;zl/rn
Date
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County
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Date
11111111111111111111111 ..J
r
GC-7B
NYS RACING & WAGERING BOARD
1 Warervliet Ave. EXL, Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
CASH CONTROL REPORT
GAMES OF CHANCE
I
j Ii:;.
Organization:j&J) PfJ~Grfl 8LJts La se ~{" () 7
J.D. No.: 13 -& -/;,,'z. -020/3 Date of License Period:1 01.$1 / rn / [ill]
Type ofMame I Type of Game Type of Game
No.1 /Jtl}cll. 'Jh.cK..1 No.2 Toi-till ~ilti'- No.3 /JIG S ;~.
Type of Game
No.4
Type of Game
No.5
Number of
Locations S-
Number of
Locations
Number of
Locations (
Number of
Locations
Number of
Locations
Starting
Bank SOO. (J(J
Starting
Bank i DO, " 0
Starting
Bank lOt). C'"
Ending
Bank 388,00
Starting
Bank
Starting
Bank
Ending ~
Bank /I~", () C
Ending
Bank 30 L/ .Ot.?
Ending
Bank
Ending
Bank
Profit or Profit or Profit or Profit or Profit or
(Loss) &SO .00 (Loss) ~O V. ()(.' (Loss) ;288,,00 (Loss) (Loss)
(A) (B) (C) (D) (E)
ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
WORKERS
WORKERS
WORKERS
WORKERS
WORKERS
( S If. If.. /) lTft -Il r d It,$ F)
L BJ-GC-78 (Rev. 4103)
Page 1 of2
CONTROL SUMMARY
PROFIT OR (LOSS)
(A) -
Game No.1 Ii 'S-O I (., ()
(B) -
Game No.2
(C) -
Game No.3
(D) -
Game No.4
(E) -
Game No.5
;20 L/ . (,10
?l- fft -00
Net Profit . J.J I I 'i J. . ~J
or (Loss) "R) "0 (.
(Enter on Line A - 2 of GC-7)
t~{lr j}C~tll1/1l,.rJ9
Prepared By
11111111111 I1111II I1I1I11 .J
Schedule 4. Assistants to Members in Charge of Games
Years
First MI Last Name Address Town Elk DaB
Frank Abato 39 Kensington Drive Hopewell Jct 9 04/24/1940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 16 05/16/1931
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 02123/1936
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 0210211957
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 01/01/1936
Kenneth J. Tucker 34 Pawling lake Pawling 7 03119/2029
Robert N. Wallner 7 Kinry Road Poughkeepsie 17 01/17/1933
I 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. A warded
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) (F) (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) (G) Profit or (Loss) (K)
Merchandise Wheel No.4 erchandise 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
I
.
(A) - Mds
Whee o. 1
(B dse.
heel 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
(1) - Mdse.
Wheel No.9
(1) - Mdse.
Wheel No. 10
(K) - Mdse.
Wheel No. 11
(L) - Mdse.
Wheel No. 12
Net Profit
or (Loss)
(Enter on Line A-3 of GC-7)
Profit or (Loss) Profit or (Loss)
~ ~ ~
OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY
~IIIIIIIIIIIII n IIII --.J
Page 2 of 2