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Wappingers Elks Lodge 2609 (8) r I GC-7 FINANCIAL STATEMENT NYS RACING & WAGERING BOARD OF GAMES OF CHANCE 1 Warervliet Ave. Ext., Suite 2 OPERATIONS 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 of Bell Jar & Charitable Gaming Compliance, 1 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. FA itS /;is 'a Zip ../)0.1 Tc hF5 ~ County 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) Number of Types of Games Zip County 3 [ZQ]/~/1Z)0 Is, Date of License Period Hours of License Period Street Address 4. Total Receipts (Add Items 1, 2 and 3)................................................................ B. EXPENDITURES - (Show only payments actually made) Describe Expenditure Payee Check No. 10 .[Q]Q] .J, ~.~ . [ili] . LiliJ . [Q]Q] .m . [ill] .10 I c> I .3 .191sl ~ '/ .[ill $ $ $ $ $ $ 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 (LIST CHECK NUMBER )..................... $ 3. Net Profit or (Loss) (Item 1 less Item 2)............................................................... $ D. GAME BANK FUND Payee Check No. Amount (MemoEntryOnJy) lc.t.'lJ AJi7ck.''/T,' flY '70t', 0(1 E. DISPOSlTlON 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....................................................................... ~~~~~~~ $ 2. Unexpended balance of net proceeds shown on last report.................................. L BJ-GC.7 (Rev. 4/03) Page 1 of 2 L Rent 2. License Fee 3. Games of Chance Equipment and Supplies l3t>b hC~tuJ/t4;71J Ill" 5. Other Expenses 81J.U LJcfN.$'€ /Jl' t I1C~{,4.",iT/J /13 0 () 3 {p ~ 4. Services .m I '" 3 7 .11m 11111111111111111111111111111 .J 50-235552 12 8 WAPPINGERS LODGE #2609 BPOE OF THE USA INC. 219 P.O. BOX 47 6801484113 I WAPPINGERS FALLS, NY 12590 DATE t. /1'2-/ " PAY TO THE '";"\ _ 1_ N Y"'" /7- owmo:J:'7cFJ~ 1-,,,, :: TJ n ""07(;; . l~' ~.,( A 1[:, . ~ru/t'"'/ '-r '1:r )1 c.-v -- -~ / Jffli~ .._,_, "\,~ J;:.A~ YORK Poughk"p';', NY 12603 d ,. v l~ MEMO-l--'":_'t._~~~---------~ I: 0 2 * 9 0 2 :i 5 2 I: II- b B 0 * ~ B ~ * * :i II- 0 * 2 8 $ )'-/9)-- lJOLLARS ~ III-I I I~ ~ 7. Total Disbursements............................................................................................ $ Ll.. I I l~ . ~ 8. U,,,,pendod bat"" of oet proceeds 0_ 61"s 1_ 7)................................... $~. 01J (Include interest bearing accounts) F. Reconciliation of Unexpended Balance (To be Completed Monthly - - Upon receipt of Monthly Bank Statement) Qe,positol}' Name of Bank Account No. Reconciled Balance 1) Checking ;3,9MK. of )I. y. &,801;;;8 '1113 1I~,:3 oj I S-I , . 2) Savings 3) Other Total (Must be the same as Line E8 - Unexpended Balance)............................... $ . W Instructions: This section must be fully completed by all 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 true, correct and complete. /)i/Tch~~ 5 County ~ / [Zg] / fo 1& I Date Last Name ;L,2 9 RD~ JNS(lJ.i lA1~1 tAl Al'l J1J crA. fA u~ 1;2 5'9 t' (i;~[]) l.zl~lf:j -111 cllfT;j ~ll1fl~~ Phone Number Signature Preparer (if different): oh Ill' FilSt Name I D t!aelJdll~ tJt. 1.:2 s 90 Sueet Address City 'p ( [fl10') I~I q[f] -I $'1 '1 I? 1'1 I Phone Number f)tJ/C hE fS County [ill] / []0 / [Qill Date JJ () '7"(:)1{' r; County ~/rn/rn Date L BJ-GC.7 (Rev. 4/03) Page 2 of 2 \\1\\1\11 \1111111111111111111 --1 I 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 CASH CONTROL REPORT GAl\1ESOFCHANCE --, Organization: 1.D. No.: Date of License Period:CD / CD / CD . Type of 1;;e Type of Game Type o,4Game Type of Game Type of Game CONTROL SUMMARY No.1 ;3 ,}t. ~bt..1<. No.2::rtJl.lJ\ !l1}t.bt No.3 G SlY No.4 No.5 PROFIT OR (LOSS) Number of Number of Number of Number of Number of (A) - II '/S?'. "0 Locations 8' Locations I Locations I Locations Locations Game No. 1 -- --- Starting Starting (B)- /;20,(}O Starting Starting Starting Game No.2 Bank 5001- (JiJ Bank / dO..... 00 Bank /00. (.lO Bank Bank (C) - Ending I S"o. 0(1 Ending Ending Ending Ending Game No.3 J 9~ ' c; () Bank Bank ;. ~ () , en;- Bank ;l c/O, (.'>0 Bank Bank (D) - -- Profit or Profit or Profit or Profit or Profit or Game No.4 (Loss) if G'D. 00 (Loss) j;;lC.(lO (Loss) I 9 () . 00 (Loss) (Loss) (A) (B) (C) (D) (E) (E) - Game No.5 .- ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY WORKERS WORKERS WORKERS WORKERS WORKERS Ll-S T ) Net Profit /I 7t:t/,()() ( ~;fli A ltl>C ht rL or (Loss) w (Enter on Line A- 2 of GC-7) RellA! j}c fLlIJ.tJ.t 1 If L BJ-GC.78 (Rev. 4103) Page 1 of2 Prepared By 111\" In" \\\" 11\11\ .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. 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. Pampa lone 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 01/1711933 I MERCHANDISE WHEELS (. Merchandise Wheel No. 1 Merchandise Wheel No.5 Merchandise Wheel No.9 CONTROLSU 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 Wh 0.1 Profit or (Loss) - Mdse. (A) Profit or (Loss) (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) (J) (G) - Mdse. 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.8 Merchandise Wheel No. 12 Recei pts (Less change b Receipts (Less change bank) Receipts (Less change bank) Net Profit or (Loss) Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded (Enter on Line A-3 of GC-7) Profit or (Loss) Profit or (Loss) ~ ~ ~ PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY Page 2 of 2 1111111111111111111111111111 .-J