Wappingers Elks Lodge 2609 (9)
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GC-7
NYS RACING & WAGERING BOARD
I Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.stute.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.
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(Please Print or Type)
FINANCIAL STATEMENT
OF GAMES OF CHANCE
OPERATIONS
Name of Organization
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Zip
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County
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Street Address Municipality
Address Where Games are Conducted, if Different:
Street Address
Zip County
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Date of License Period Hours of License Period
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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)
4. Total Receipts (Add Items 1, 2 and 3)................................................................
B. EXPENDITURES - (Show only payments actually made)
Describe Expenditure Payee
Check No.
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) Lot,' I~ /JH 10 Lv 11; --11L- 7 Of) j 00
E. DISPOSITION 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 IU.GC.7 (Rev. 4/03) Page 1 of 2
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6. Total Expenditures..................................................... ............... ..................... ...... $
C. NET PROFIT OR (LOSS). $
I. Profit or (Loss) Before Additional License Fee (Item A4 less Item B6)...............
)..................... $
1. Rent
2. License Fee
3. Games of Chance Equipment
and Supplies
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5. Other Expenses
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4. Services
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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 bearing account(s)............ $
5. Other deposits into or adjustments in Special Games of Chance Account............ $
Explanation
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6. Total net proceeds (add Items 1 through 5).......................................................... $
Disbursements of net proceeds since last report: (Attach additional sheets if necessary)
~ D/;e I, Check No. . D.:.scriotion of Disbursements Name & Address of Payee
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Amount
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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)
Depository Name of Bank Account No. Reconciled Balance
1) Checking 8A-ttJ./L oP /-1,1, t8o/'I8 'IjJ,j 1J~1.27/. '1'1
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 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.
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Zip
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County
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Date
First Name
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Street Address Cily
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Phone Number
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L DJ.GC.7 (Rev. 4/03)
Page 2 of2
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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
GAMES OF CHANCE
-,
Organization:
I.D. No.:
Date of License Period.IT] / IT] / IT]
Type of Game Type of Game Type of Game Type of Game Type of Game CONTROL SUMMARY
No.1 AlA cJ{.:::Jftc/t.. No.2 -::[bMA. //;,laJl No.3 (J/(j S/~ No.4 No.5 PROFIT OR (LOSS)
Number of Number of Number of Number of Number of (A) - f 042.00
Locations ~ Locations i Locations i Locations Locations Game No. 1
Starting ~ Starting Starting Starting (B)- -() -
Starting Game No.2
Bank ~bi,,(),1 Bank /O().O~ Bank 10 () , CJG' Bank Bank
(C) -
Ending Ending Ending Ending Ending Game No.3 -0 -
Bank .5" J;). I 0 (J Bank / ()O . {I C1 Bank I () (). (1(,1 Bank Bank
(D) -
Profit or Profit or Profit or Profit or Profit or Game NO.4
(Loss) ~.O() (Loss) -0 - (Loss) ~o "7 (Loss) (Loss)
(A) (B) (C) (D) (E) (E) -
ENTER PROFIT OR (LOSS) FOR EACH TYPE OF GAME ON CORRESPONDING LINE OF CONTROL SUMMARY Game No.5
WORKERS WORKERS WORKERS WORKERS WORKERS 1I;l;J. C' ,7
Net Profit
(Slill j) 'iT /}-c h 11~ i~ or (Loss)
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(Enter on Line A-2 of GC-7)
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L BJ.GC.7B (Rev. 4103)
Page 1 of2
Prepared By
IIII1III11111 ~IIIIIIIIII ..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 07101/1936
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 CONTROLSU y-
Receipts (Less change bank) Receipts (Less change bank) Receipts (Less change bank) PROFIT OR OSS)
(A) - Mds .
Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded Less: Value of Mdse. Awarded Whee o. 1
Profit or (Loss) Profit or (Loss) Profit or (Loss) (B dse.
(A) (E) 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 ba 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. 12
Receipts (Less change bank) Receipts (Less change bank) Receipts (Less change bank) Net Profit
or (Loss)
Less: Value of Mdse. Awarded Less: Value of Mdse. A warded
(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
Page 2 of 2
WI 11111111 IIUIIIII .J