Untitled
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COlSEY
TOWN COUNCIL
WilLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOlONI
TOWN CLERK'S OFFICE
20 MIDDlEBUSH ROAD
WAPPINGERS FAllS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
September 26th, 2008
New York State Racing and Wagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject:
Games of Chance License - Wappinger Elks #2609
Please find enclosed the GC-2, GC-2A, GC-2B, GC-4, GC-5, for the Wappinger Elks
#2609 Event to be held on November 7th, 2008.
12c~~
J'hhn C. sterson
1lown Clerk
Town of'Vappinger
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COLSEY
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P PAOLONI
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
September 26th, 2008
Wappingers Elks #2609
PO BOX 47
Wappingers Falls, New York 12590-0047
ATTN: Rocco Valente
Dear Mr. Valente:
Please find enclosed the "License to Conduct Games of Chance" for
your Las Vegas Night to be held on November 7th, 2008. I have also attached
a receipt for your payment.
Please do not hesitate to contact my office with any further questions
or concerns.
Sincerely,
r
GC-5
NYS RACING & W AGERINCi BOARD
I Broadway Center. Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (518) 347-1469
wWVI'.racing.slale.ny.us
-,
GC - GLJ - GEI;J- ~-
N.Y.S. Identification Number
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE !XI
BELL JAR 0
RAFFLE 0
GLJiliLJ
This License Must Be
Conspicuously Displayed
During Conduct of Games
$1 25.00 II
Amount of Fee Paid Lessor's License Number
Address: 1195 Route 376 City: Wappingers Falls, NY
Entire net proceeds to be devoted to the following specific lawful purpose(s):
1/3 Charitable 2/3 Operations
Names of Members in Charge
Paul Bader
Zip Code: 12590
Simon Kaufman
Lew Hakim
Greg Sarno
LlCENSE PERIOD
DATE
November 7, 2008
DAY OF WEEK
HOURS TYPE(S) OF GAMES
Friday
7:00 PM - 12:00 PM Black Jack, Poker, Big Six Wheel
RAFFLE DRAWING
DATE
DRA WING TIME
DRAWING LOCATION
AMOUNT OF RAFFLE PRIZES (Cash or Merchandise Prizes
al FaIr Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
I THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
I FOR EACH TYPE OF GAME OF CHANCE
3 $ 500.00
NUMBER OF GAMES EACH GAME (Starting Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
EACH WHEEL
NUMBER OF WHEELS
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
ST ATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
Issued by Town of Wappinger
(Name of Municipality)
QP4lio1,,)
L BJ-GC-5 (Re\'. 3/06)
Town Clerk
(Title of Authorized Officer)
t'
~
re of Authorized Officer)
11111111111111111111111111111 -1
r
GC-4
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ex!., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
-,
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
GC - GJl] - GIiliJ - GLIJ - c;r;LIiliJ
N.Y.S. Identification Number Municipal License Number
Town of Wappinger
Name of Municipality
1195 Route 376. Wappingers Falls. NY 12590
Address
After investigation, and a hearing if required under Sec. 1 Q. of the General Municipal Law, the following findings and detenuinations
have been made:
2. Applicant is a qualified authorized orga . ation as defined in the Games of Chance Licensing Law.
3. All the members designated in the application to conduct games are bona fide active members of the applicant
organization.
4. The premises presently owned or occupied by the applicant are in every respect adequate and suitable for
conducting games of chance.
5. The games of chance are to be conducted in accordance with the provisions of the Games of Chance Licensing
Law, the Rules and Regulations of the N.Y.S. Racing and Wagering Board, and local ordinances.
6. The entire net proceeds are to be devoted exclusively to one ore more of the "lawful purposes" as defined in the
Games of Chance Licensing Law and the Rules and Regulations of the N.Y.S. Racing and Wagering Board.
7. There is satisfactory proof that no commission, salary, compensation, reward or recompense will be paid or
given to any person for conducting the games or assisting therein, except to the extent authorized by the Games
of Chance Licensing Law and the Rules and Regulations of the N.Y.S. Racing and Wagering Board.
8. There is satisfactory proof that the type and value of prizes offered and given will be in accordance with the
provisions of the Games of Chance Licensing Law.
9. If applicable, the rent to be paid to an authorized games of chance lessor is reasonable.
DNa
1. All the members-in-charge designated in the a
character and have never been convicted of c
Signature of Person Conducting Investigation'
I:XI Yes DNo
lXI Yes DNo
Gt Yes DNo
lXI Yes DNo
~Yes DNa
\Xl Yes DNo
0Cl Yes DNo
IKl Yes DNo
:-.J Yes DNo
10. Other findings: (Specify)
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED ~icense is DENIED 0
Signature of '
Filing date of Application September 16, 2008 Authorized Officer
Date q \ ~5IJ(jD 'iF Title
\
ONE COpy OF THIS FORM TOGETHER WITH ONE COpy OF FORM GC-2, 2A, 2B MUST BE RECEIVED BY THE
N.Y.S. RACING AND WAGERING BOARD FIVE DAYS PRIOR TO THE FIRST AUTHORIZED LICENSE PERIOD.
L BJ-Ge-4 (Rev. 4/03)
1111111111 1\111\ 111111 \111111 .-J
TOWN OF WAPPINGER
TOWN CLERK
SUPERVISOR
CHRISTOPHER J. COLSEY
CHRIS MASTERSON
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P PAOLONI
September 16, 2008
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, NY 12601
Dear Sheriff Anderson:
Enclosed, please find a copy of the members of the Wappinger Elks #2609,
Route 376, Town of Wappinger, who will be conducting Games of Chance
on November ih, 2008.
I would appreciate your review of the "Members in Charge" listed on the application.
Please complete the "Findings and Determination" form attached and return the form
to our office.
Thank you for your attention to this request and your prompt reply.
Yours truly,
Ene.
,
-,
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ext., SUil~ 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.sI8te.ny.us
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE ~
BELL JAR 0
RAFFLE 0
GC-2
FOR OFFICE
USE ONLY
$[ ,}S,Cb 1
Fees Received
[OIlJ Il~1)17to18]
Dale
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
Ge[d?>\- oom- [~Or.:LJ- ~
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
~LcW 0 r wl1f('ltJ~R DVTe..lt ~S5
Name of Municipality County
l.
2.
3. Has applicant ever been denied a games of chance license? 0 Yes P(NO If "yes", why? (Attach extra sheet if necessary)
4. Check type of organiz.ation and. if applicable, give the State and date of incorporation.
Corporation 0 ~
~ Stale incorporated tJfLt0 {)
Inc",I'"''''''' Assod"ion I'-", -. .
Unincorporated Association 0
State incorporated
Dnte [QIC;J I rn I [81 r]
DnteITJ/ITJ/ITJ
lndi vidual
o
s. Did your corporate status change since your identification nn~r was assigned? 0 Yes ~o
6. Are you uoing business under a trade name? 0 Y es ~o If "yes", what is the trade name?
PART B. LOCATION OF GAMES
7. Add"ss whore g.""'. b,1l j". ot mffl, d"wing(') = to be conducwl-l t q ~ f<it:3> 7 (d w f.t-f(l , ~ ~ ( NI( ,/
8. Name and address of authorized games of
chance lessor renting to applicant.
tJ[ A
9. Does the applicant own the premises? ~es
o No If "yes". how long'!
1 O. Capacity for public assembly of premises presently owned or occupied. :J- \? t;?
11. Have premises been regularly used? ~es 0 No If "yes", how long? )...0 i r:z.AR 7
Are games of chance being played now on these premises or has it ever been? l;i. Yes 0 No If "yes". give full details.
C;~''f'\ ~ S, J- to 8
12. Are the premises or any part thereof
where games of chance are to be played
licensed by the State Liquor Authority?
] 3. Has such license ever been
revoked or suspended? 0 Yes
'Ob'.es 0 No
If "yes". slate the type of license and number.
c...L - 0 0 f) 7 Lf - J- lI: 3>
~o
If "yes", why? (Explain on a separate sheet, if necessary. and attach.)
L BJ-GC-2 (Kev. 4/03)
Page 10f2
11111111111111111111111111111 ..J
r
I
PART C. PURPOSES OF GAMES
14. State t~e .S..PecifiCWes for which the entire net proceeds are to be de.Yoted and in what m.anner.
l ('7, c .. (TJ) ~U~ d-l~ Of' iZf<.Jt-ll V ~L') S
I swear (or affinn):
1. That ALL the attached Schedules are a material part heroof and are incorporated herein as if set out in full in the application. All the answers
contained in this application are a material part hereof.
2. That the entire net proceed.'i ofall games of chance shall be devoted exclusively to one or more of the "lawful purposes" as defined in the Games of
Chance Licensing Law and the Rules and Regulations of the Board.
3. That for each license period for V'tnich a license is sought, one or more of the active members under whose supervision the games are to be held,
operated and conducted, who is familiar with the Games ofCbance Licensing Law, the Rules and Regulations of the N. Y.S. Racing & Wagering
Board and local licensing ordinances or laws, will be present at all times, in charge and primarily responsible for the conduct of games.
4. That the undersigned will be responsible for the holding, operation and conduct of all games of chance in accordance with the terms of the license,
the provisions of the Games of Chance Licensing Law, the Rules and Regulations of the N.Y.S. Racing & Wagering Board and with the provisions
oflocallicensing ordinances or laws.
5. That the undersigned has read and is familiar with the provisions of the Games ofCbance Licensing Law as amended, the Rules and Regulations
of the NYS. Racing & Wagering Board, and the local licensing ordinances or laws.
6. That no commission, salary, compensation, reward or recompense will be paid to any person for holding or assisting in the operating or
conducting of the games, except to bookkeepers or accountants for profe~ services in an amount not exceeding that fixed by the Board.
[Qli] I IT@ 11018'1 /2occo ~.... j( 0 Ceo v'!f(FiV,c-
Date Signature of Head of Organization Print Name
STATE
OF
NEW YORK
}ss
COUNTY
OF U l)'Tc...~~ 5
OF U.)'A,~/Vvl aL
J2 0 C c.. l) VA l...cz ;.JTE. being duly sworn deposes and says that (s)he is the person above named,
that (s)he has read the foregoing statement and the answer therein noted, and that such answers are true and that (s)he has personally
affixed his (her) signature to this affidavit.
CITY~N1LLAGE
~~ ~
Sworn 191 before me this ./ ~ day of. 0
~f;~,L
. Notary Public
My Commission expires ~ '2,0
,20~
Sign" vL-.~fv<>
./ (
Commissioner of Deeds
, 20UL-
SARA J DOBBINS
Notary Public. State of New York
Qualified in Dutchess County
Cer1ified in Westchester County
Commission No. 01 D04865746
Commission Expires dttly-2~~! ,,)0 10
L BJ-GC-2 (Rev. 3/0~~~i')(;;()
Page 2 of2
1111111."11 .-J
r
GC-2A
--,
APPLICATION FOR GAMES OF CHANCE LICENSE
,...~~
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NYS RACING & WAGERING BOARD
1 Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (518) 347-1469
www.racing.state.ny.us
GC- [l:ill- CiliB]- ~ - ~ [[] I [[] I [[]
NYS Identification Number Date
SCHEDULE 1: OFFICERS AND DIRECTORS
List names, addresses and dates of birth of all officers.
If organization is a corporation, or an incorporated or unincorporated association, list officers and directors.
TITLE NAME DATE OF BIRTH STREET ADDRESS CITY ZIP
~ 1 I I I i
fV~ I ~f:(~vr'71-1=1=1
i 1_1_1_1
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1=1=1=1
1 I I I
1=1=I=i
1_1_1_1.
1_1_1_1
1_1_1_1
1_1_1_1
Attach additional sheet if necessary.
SCHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF
NAME OF BIRTH MEMBERSHIP STREET ADDRESS CITY ZIP
\Jtd-V' L. ~ ~O efL3.1 ').-0 I b.SJ I i-f I ~ ~ 4: lk.:'O Rt1iW~ R~ t-AC~v't~ J..~'D
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G-tW'fi-- ~;4Rf.90 I ~I RLI ';~ I :J-~ I \7, OJ}Vi}- f'L-il-Clnz kMJ'l1HJ,.~ 1;}~ 0
I I I I \ i
1=1=1=1 1 1
I I I 1 I
1-1-1-1 i
1=1=1=1
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 AUXILJARIESlAFFILIA TES. EACH AUXILIARY/AFFILIA TE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXILIARY/AFFILIATE
GAMES OF CHANCE ill NUMBER
111111111111 .J
L BJ-GC-2A (Rev. 3/06)
Page 1 of2
Schedule 1: Officers and Directors
WAPPINGER LODGE #2609 OFFICERS for 2008-2009
Title Name Address Town Zip DOB
---------------------- --------------- -------------------------- ------------------------------ -------------------...--------...- ...
Exalted Ruler Rocco Valente 61 Fishkill Hook Rd. Hopewell Jct. 12533 06/06/1941
Leading Kgn Mark H. Fox 28 Tiger Road Hopewell Jct. 12533 09/15/1957
LoyalKgn Eileen E. Boyer 134 Andrews Road Lagrangeville 12540 01/0211943
Lect. Kgn Vacant
Esquire Anthony M. Storzieri 26 Cobey Terr. Poughkeepsie 12601 07/07/1936
Chaplain Catherine Rohling 54 Brothers Road Wappinger Falls 12590 04/22/1940
Inner Guard Vacant
Secretary Robert M. Acquanita 10 Vorndran Dr. Wappinger Falls 12590 OS/25/1942
Treasurer Pamela S. Kultsar 58 Hillis Terrace Poughkeepsie 12603 02/01/1950
Tiler Susan Dorler 21 Valley Road Wappinger Falls 12590 03/29/1939
Trustee James Boyer 134 Andrews Road Lagrangeville 12540 11/28/1937
Trustee Salvatore Filippone 13 Ravine Road Hyde Park 12538 07/17/1931
Trustee Dana Mills Pawling Lake Box 17 Pawling 12564 02/18/1971
Trustee Joseph W. McDowell 127 Innis Ave. Poughkeepsie 12601 04/21/1941
Trustee Vacant
No Officer receives compensation of any kind.
r SCHEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE OF GAMES
List all members of applicant organization and members of authorized affiliates and auxiliary who will assist with gameso Each person listed must be a
member of applicant organization or affiliate for at least I yearo
YEARS OF
MEMBER NAME DATE OF BIRTH MEMBERSHIP STREET ADDRESS
I , , I 1
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L BJ-GC-2A (Rev. 3106)
Attach additional sheet if necessary.
Page 2of2
II11II1IIII .-I
Schedule 4. Assistants to Members in Charge of Games
Years
First MI Last Name Address Town Elk DOB
Frank Abato 39 Kensington Drive Hopewell Jet 11 04/2411940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 18 05/16/1937
Robert Acquanita 10 Vorndran Drive Wappingers Falls 22 OS/25/1942
Ralph J. Anzivina 12 Thorns Lane Highland 22 12121/19~5
Henry J. Boldrin 28 Gold Road Wappinger Falls 15 01/11/1936 _
Harold A. Crawford Sr. 318 Sunset Hill East Fishkill 18 02123/1936
Francis J. DeGano 27 Brandy Lane Wappingers Falls 18 07/18/1946
Roger DeJordy 83 Kent Road Wappingers Falls 18 09/19/1944
Robert Fischetti 91 Ardmore Drive Wapplngers Falls 28 06/07/1926
Mark H. Fox 28 Tiger Road Hopewell Jet. 14 09/15/1957
Harris C. . Jones 217 Brothers Road Stormville 18 04/24/1944
Robert J. Juliano 2776 West Main Street Wappingers Falls 13 10/05/1953
William K. Minkowski 427 McGrath Blvd. Fishkill 28 03/20/1942
Rosemarie Perretta 35 Cathy Road Poughkeepsie 8 09/07/1943
Gregory F. Sarno 13 Dana Place Wappingers Falls 28 07/01/1936
Kenneth J. Tucker 34 Pawling Lake Pawling 9
Robert N. Wallner 7 Klnry Road Poughkeepsie 19 01/17/1933 -
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r SCHEDULE 7 TYPES OF GAMES -,
List all of the single types of games to be conducted at all license periods enumerated in Schedule 5.
Note for Vellas Ni2hts and Bazaars only: The total amount of prizes during anyone license period shall not
aggregate more than $400 for each single type of game of chance when five types of games of chance are to be
conducted during anyone license period. The total amount of prizes during anyone license period shall not
aggregate more than $500 for each single type of games of chance when less than five single types of games of
chance are to be conducted during anyone license period.
LIST NAME OF EACH TYPE OF
GAME OF CHANCE
(limit: 5 Games)
~l-\\-C t~Jtt C\L-
-:r Oli-tByt. 1P Oi~YL
~L G- S\ 'I--. tl9~~
For Merchandise Wheels, Bell Jars and Raffles, please complete the appropriate spaces below.
MERCHANDISE WHEELS:
INDICATE NUMBER OF
MERCHANDISE WHEELS
(NO LIMIT)
THE TOTAL AMOUNT OF PRIZES FOR
EACH MERCHANDISE WHEEL SHAlL
NOT EXCEED $10,000 AND NO SINGLE
PRIZE SHAlL EXCEED $250
.,;k'
BELL JAR:
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BELL JAR DEAL SHALL NOT
EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500
INDICATE IF THIS APPLICATION
IS FOR A BELL JAR
LICENSE
YESO NO 0
RAFFLES:
INDICATE IF THIS APPLICATION
IS FOR A RAFFLE
LICENSE
YESO NO 0
IF YES, LIST RAFFLE DATES, TIME(S)
OF ORA WING(S) AND PRIZES IN
SCHEDULE 5
THE TOTAL AMOUNT OF PRIZES FOR
ALL THE RAFFLES CONDUCTED DUR-
ING THIS CAlENDAR YEAR SHAll.
NOT EXCEED $100,000. NO SINGLE
PRIZE SHALL EXCEED $50,000
EXCEPT THAT A SINGLE PRIZE OF
$100,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L BJ-GC-ZB (Rev. 4/03)
Page 2 of2
1111111 \11\11\1 1I1I .J
I
-,
\'
FOR OFFICE
USE ONLY
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE uf
BELL JAR 0
RAFFLE 0
$ [ d 5 ' uO ] OOllTJ-DlatLJe I / (01 81 -1
Fees Received ~
GC-2
NYS RACING & WAGERING BOARD
I Walervliel Ave. EXl., Suilt: 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.st8Ie.ny.us
INSTRUCTIONS; PLEASE FILE THREE SIGNED COPlES WITH MUNICIPALITY
GC-I t 13J- ooru-I~Iohi-l- ~
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
---1'ii U.?'IJ 0 f' wllffl ~~R D vrc:.lt f2'-S..s
Name of Municipality County
2.
3. Has applicant ever been denied a games of chance license? 0 Yes P(NO If "yes". why? (Attach extra sheet if necessary)
4. Check type of organization and, if applicable, give the State and date of incorporation.
Corporation 0 \.J fi\ () V'
I",",pon"&I "',od'lioo ~ SIale inooq>o<ated !Jl'Z-tV ~
Unincorporated Association 0
State incorporated
Date ~ / rn / [B:f iJ
Datem/m/ITJ
lndi vidual
o
5. Did your corporate status change since your identification Il~r was assigned? 0 Yes ~o
~o If "yes", what is the trade name?
6. Are you doing business under a trade name? 0 Yes
PART B. LOCATION OF GAMES
7. Address where games. bell jar. or raffle drawing(s) are 10 be conducted. 1 t q ~
f<\t ..J, 7 fa. w If+f(J , HkJ.. >( NJ<( /'
8. Nome ond address of authorized games of
chance lessor renting to applicant.
~l A
9. Does the applicant own the premises? ~es
o No If "yes", how long'!
10. Capacity for public assembly of premises presently owned or occupied. .J..- \? ~
11. H.ave premises been regularly used? ~es 0 No If "yes", how long? :;"'0 i'~ 7-
Are games of chance being played now on these premise:s or has it ever been? Ql Yes 0 No If "yes". give full details.
C::>~''fT'' S, ;}.- to 8
12. Are the premises or any part thereof
where games of chance are to be played
licensed by the Stale Liquor Authority?
"Db'.es 0 No
If "yes". slate the type oflicense and number.
c.L - 001)7 t..f -J. lf 3
13. Has such license ever been 0 Y f"ooIlN,o If "yes". why? (Explain on a separate sheet. if necessary. and attach.)
revoked or suspended? es "7~
L BJ-GC-2 (kev. 4/U3)
Page 1 of2
1111111111 \1111\ 1111111111111 .J
r
I
PART C. PURPOSES OF GAMES
] 4. State 1l}es ....Pecific~es for which the entire net proceeds are to be de.voted and in what manner.
{ (2, C . OJ) tSu~ J-l~ Of' ~~ff1l V tv S
I swear (or affmn):
1. That ALL the attached Schedules are a material part heroof and are incorporated herein as if set out in full in the application. All the answers
contained in this application are a material part hereof.
2. That the entire net proceeds of all games of chance shall be devoted exclusively to one or more of the "lawful purposes" as defined in the Games of
Chance Licensing Law and the Rules and Regulations of the Board.
3. That for each license period for which a license is sought, one or more of the active members under whose supervision the games are to be held,
operated and conducted, who is familiar with the Games of Chance Licensing Law, the Rules and Regulations ofthe N.Y.S. Racing & Wagering
Board and local licensing ordinances or laws, will be present at all times, in charge and primarily responsible for the conduct of games.
4. That the undersigned will be responsible for the holding, operation and conduct of all games of chance in accordance with the tenns of the license,
the provisions of the Games of Chance Licensing Law, the Rules and Regulations of the N.Y.S. Raeing & Wagering Board and with the provisions
oflocallicensing ordinances or laws.
5. That the undersigned has read and is familiar with the provisions of the Games of Chance Licensing Law as amended, the Rules and Regulations
of the N.Y.S. Racing & Wagering Board, and the locallieensing ordinances or laws.
6. That no commission, salary, compensation, reward or recompense will be paid to any person for holding or a<lsisting in the operating or
conducting of the games, except to bookkeepers or accountants for professional services in an amount not exceeding that fixed by the Board.
[Q81/ [ilij/I ~81 ~.~..
Date Signature of Head of Organization
/( OCCe;>
Print Name
V...yLEiVTe
ST ATE
OF
NEW YORK
}ss
OFuuTC-~~5
CITY~NILLAGE OF WltpprlJ'jEi.- FAU-S
,~ C. C (.) VAL e;,..:,' TE.. being duly sworn deposes and says that (s)he is the person above named,
that (s)he has read the foregoing statement and the answer therein noted, and that such answers are true and that (s)he has personally
affixed his (her) signature to this affidavit
COUNTY
day of # ' 201..L
ru
Public
"goedy(' iFx~
Commissioner of Deeds
My Commission expires (]1 ~ ':1.,.)
SARA J, DOBBINS
Notary Public, State of New Yorl<
Qualified in outchess County
Certilied in Westchester County
Commission No. 010~486~460
commission ExP\reS~' ~
,20~
L BJ-GC-2 (Rev. 3/06)
".-
~~I;)QJ1 C
Page 20f2
11"111111111111 .J
r
GC-2A
I
APPLICATION FOR GAMES OF CHANCE LICENSE
.....~:.
~., J:., " _~ ."_._'.' ...~~:;: .
t~ .l.~t.
\t t~\ .:::~',~ .r
NYS RACING & WAGERING BOARD
1 Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (518) 347-1469
www.racing.state.ny.us
I ~. 'I ! -," ,\~
UJ {7 P \. ~ 6- yrj.
Name of Organization
GC- [ill] - CiliB] - ~- ~
NYS Identification Number
SCHEDULE 1: OFFICERS AND DIRECTORS
List names, addresses and dates of birth of all officelS.
If organization is a corporation, or an incorporated or unincorporated association, list officelS and directors.
TITLE NAME DATE OF BIRTH STREET ADDRESS
~ 1_1_1_1
~ I~H~~l_I_I_1
, I 1 1 1
I i___
! 1 1 I
\_--
1_1_1_1
1_1_1_1
1_1_1_1
1_1_1_1
1_1_1_1
1_1_1_1
1_1_1_1
Attach additional sheet if necessary.
[IJ/[IJ/[IJ
Date
CITY
ZIP
SCHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZA nON)
DATE YEARS OF
NAME OF BIRTH MEMBERSHIP STREET ADDRESS CITY ZIP
\Jij-v L. ~ ~O ll~ 1 '),-01 bSJ 'i-f 1 l ~ 4: IHv?() RJfWt? R~ L.ec~V\~J J.,)'-i'D
~\ t'\OV K(Jvr4i~/~1 L ~I '7,0 I-LI q S.V~ftW lAJ. l'lJ-of~, J<.lt. ')-,S-~""b
LJfuJ Y-A-t-<IJ:LI-2/2=J1 \{ 5l ~ 1:7f6)~ ~~u;.I\JJi4f>P.(~t>, t>-s-q'O
~fr Cf?ARJ901~/J2L/~~1 J-~ 1\~Ob-.,l)-r/./tl-CtZZ ~ 1~0l0
\ 1 1 I I \
1=1=1=1 \
I 1 1 I I
\-1-1-\ I
1=1=1=1 I
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 AUXll..IARIESI AFFILIATES. EACH AUXll..1AR YI AFFILIATE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXllJARY/AFFILIATE
GAMES OF CHANCE ID NUMBER
III1IIIIIIII .J
L BJ-GC-2A (Rev. 3/06)
Page 1 of2
Schedule 1: Officers and Directors
WAPPINGER LODGE #2609 OFFICERS for 2008-2009
Title Name Address Town Zip DOB
---------------------- --------------- -------------------------- ------------------------------ ------------------------..----- -
Exalted Ruler Rocco Valente 61 Fishkill Hook Rd. Hopewell Jet. 12533 06/06/1941
Leading Kgn Mark H. Fox 28 Tiger Road Hopewell Jet. 12533 09/15/1957
LoyalKgn Eileen E. Boyer 134 Andrews Road Lagrangeville 12540 01/02/1943
Lect. Kgn Vacant
Esquire Anthony M. Storzieri 26 Cobey Terr. Poughkeepsie 12601 07/07/1936
Chaplain Catherine Rohling 54 Brothers Road Wappinger Falls 12590 04/22/1940
Inner Guard Vacant
See reta ry Robert M. Acquanita 10 Vorndran Dr. Wappinger Falls 12590 OS/25/1942
Treasurer Pamela S. Kultsar 58 Hillis Terrace Poughkeepsie 12603 02/01/1950
Tiler Susan Dorler 21 Valley Road Wappinger Falls 12590 03/29/1939
Trustee James Boyer 134 Andrews Road Lagrangeville 12540 11/28/1937
Trustee Salvatore Filippone 13 Ravine Road Hyde Park 12538 07/17/1931
Trustee Dana Mills Pawling Lake Box 17 Pawling 12564 02/18/1971
Trustee Joseph W. McDowell 127 Innis Ave. Poughkeepsie 12601 04/21/1941
Trustee Vacant
No Officer receives compensation of any kind.
r SCHEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE OF GAMES
, List all members of applicant organization and members of authorized affiliates and auxiliary who will assist with games, Each person listed must be a
member of applicant organization or affiliate for at least I year,
YEARS OF
MEMBER NAME DATE OF BIRTH MEMBERSHIP STREET ADDRESS
\ , , \_1
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1='='= \ - \
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CITY
ZIP
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L BJ-GC-1A (Rev. 3106)
Attach additional sheet if necessary.
Page 2 of2
IIII1IIIIII ..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 11 04/2411940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 18 06/16/1937
Robert Acquanita 10 Vorndran Drive Wappingers Falls 22 06/26/1942
Ralph J. Anzivina 12 Thorns Lane Highland 22 12121/19~_6
Henry J. Boldrin 28 Gold Road Wappinger Falls 16 01/11/1936 _
Harold A. Crawford Sr. 318 Sunset Hill East Fishkill 18 02123/1936
Francis J. DeGano 27 Brandy Lane Wappingers Falls 18 07/18/1946
Roger DeJordy 83 Kent Road Wappingers Falls 18 09/19/1944
Robert Fischetti 91 Ardmore Drive Wappingers Falls 28 06/07/1926
Mark H. Fox 28 Tiger Road Hopewell Jct. 14 09/16/1967
Harris C. ' Jones 217 Brothers Road Stormville 18 04/24/1944
Robert J. Juliano 2776 West Main Street Wappingers Falls 13 10/05/1953
William K. Minkowski 427 McGrath Blvd. Fishkill 28 03/20/1942
Rosemarie Perretta 35 Cathy Road poughkeepsie 8 09/07/1943
Gregory F. Sarno 13 Dana Place Wapplngers Falls 28 07/01/1936 ,',
Kenneth J. Tucker 34 Pawling Lake Pawling 9
Robert N. Wallner 7 Kinry Road poughkeepsie 19 01/17/1933.
o ~-el '}.rr~1i{QTCJ d-\irn 'lL z.'-L.:(} b 11 ~()'C\ o-~~-t.s-t'd~~M-'-rJO()W1!
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r SCm:DULE 7 TYPFS OF GAMES --,
List all of the single types of games to be conducted at all license periods enumerated in Schedule 5.
Note for Vee:as Nie:hts and Bazaars only: The total amount of prizes during anyone license period shall not
aggregate more than $400 for each single type of game of chance when five types of games of chance are to be
conducted during anyone license period. The total amount of prizes during anyone license period shall not
aggregate more than $500 for each single type of games of chance when less than five single types of games of
chance are to be conducted during anyone license period.
LIST NAME OF EACH TYPE OF
GAME OF CHANCE
(Limit: 5 Games)
t7L-1\C t~:r~ C-\L
:r OtL--~r:L 'P Dt~Yl-
~L G-- s,~ tO~~
For Merchandise Wheels, Bell Jars and Raffles, please complete the appropriate spaces below.
MERCHANDISE WHEELS:
INDICATE NUMBER OF
MERCHANDISE WHEELS
(NO LIMIT)
THE TOTAL AMOUNT OF PRIZES FOR
EACH MERCHANDISE WHEEL SHALL
NOT EXCEED $10,000 AND NO SINGLE
PRIZE SHALL EXCEED $250
.J
BELL JAR:
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BEU. JAR DEAL SHALL NOT
EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500
INDICATE IF1IDS APPLICATION
IS FOR A BELL JAR
LICENSE
YESO NO 0
RAFFLES:
INDICATE IF THIS APPLICATION
IS FOR A RAFFLE
LICENSE
YESO NO 0
IF YES, LIST RAFFLE DATES, TIME(S)
OF DRA WING(S) AND PRIZES IN
SCHEDULE 5
THE TOTAL AMOUNT OF PRIZES FOR
ALL THE RAFFLES CONDUCTED DUR-
ING THIS CALENDAR YEAR SHALL
NOT EXCEED $100,000. NO SINGLE
PRIZE SHALL EXCEED $50,000
EXCEPT THAT A SINGLE PRIZE OF
$100,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L BJ-GC.2B (Rev. 4/03)
Page 2 of2
111111111111111011 .J
Pay to the
Order of
\.>~r.
561 113 ~5 -
n Ez~shiefd~check
~Fraud Protection . .
Date 6
$ J'b/f...-
~'\
ERNA KAUFMAij
9 SOUTH VIEW LANE:
HOPEWEll JUNCTION, NY 12533
JPMORGAN CHASE SANk )
~'~~ -~~~
I: 0 2 2 :I DOl? :I I: ! 0 2 ? ~ ~ 0 :I b 5 ~ III . . :I b
@CHECKGALLERY, 1995 STYLE #- P03 1-800-354-340 wWw.checkgallery_com
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