The 4065 Club
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COLSEY
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
June 1 ih, 2008
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, New York 12601
Dear Sheriff Anderson:
Enclosed, please find a copy of Members in Charge" for The 4065 Club, Inc., 339 Route
82, Wappingers Falls, New York, who will be selling BELL JAR Tickets on their
premises throughout the year 2008.
I would appreciate your review ofthe application. Please complete the "Findings and
Determination" form attached and return the completed application to my office.
Thank you for your attention to this request and your prompt reply.
Sincerely,
r
GC-4
NYS RACING & WAGERING BOAIW
] Watervliet Ave. EXl., Suite 2
Albany, NY ] 2206.] 668
Telephone (5J 8) 453-8460 Fax (5]8) 453-8492
www.racing.stute.ny.us
--,
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
GC - [l]J] - GI!I;J - GLLJ - GEILG:LJ
N.Y.S. Identification Number
Town of WRp~ingpr
Name of Municipa ity
339 Route 82. Wappingers Falls. New York 12SQO
Address
unicipal Law, the following findings and detenninations
~es DNo
After investigation, and a hearing if required under Sec. 192 of th
have been made:
1. All the members-in-charge designated in the appli
character and have never been convicted of a c.' e
Signature of Person Conducting Investigation
e
2. Applicant is a qualified authorized organization as defined in the Garnes 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 everyrespect 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 Garnes of Chance Licensing Law.
9. If applicable, the rent La be paid to an authorized games of chance lessor is reasonable.
lO. Other findings: (Specify)
KJ Yes DNa
KJ Yes DNo
ID Yes DNo
J[] Yes DNa
~Yes DNa
!if] Yes DNo
I[] Yes DNa
~Yes DNa
DYes DNa
TO BE COMPLETED BY MUNICIPAL CLERK: ,r
As a result of the frndings and determinations stated above, license is GRANTED alicense is DENIED 0
Signature of
Filing date of Application June 17 th, 2008 Authorized Officer
Date ~\ oB' Title Town Clerk
ONE COPY OF THIS FORM TOGETHER WITH ONE COPY OF FORM GC-Z, ZA, ZB MUST BE RECEIVED BY THE
N.Y.S. RACING AND WAGERING BOARD FIVE DAYS PRIOR TO THE FillST AUTHORIZED LICENSE PERIOD.
L BJ-GC-4 (Rev. 4/03)
11111111111111111111111111111 ~
I
I
;1
'!
I
TO ,N C fRK
CHRIS ~ ERSON
TOWN OF WAPPINGER
SUPERVISOR
CHRISTOPHER J. COLSEY
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
July 21 S\ 2008
New York State Racing and \Vagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject:
BELL JAR LICENSE - The 4065 Club Inc. - 2008
Please find enclosed the GC-2, GC-2A, GC-2B, and GC-5 for The 4065 Club Inc.
for the year of 2008.
(f)-c1i~
6luhn C. Masterson
Town Clerk
Town of Wappinger
r
GC-4
NYS RACING & WAGERING BOARD
] Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone (5 18) 453-8460 Fax (5 I 8) 453-8492
www.racing.state.ny.us
I
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
GC-GLJ-~-~-~
N.Y.S. Identification Number
Town of W~p~ingpr
Name of Municipa ity
339 Route 82. Wappin~ers Fall~. New York l?~qO
Address
unicipal Law, the following findings and determinations
~es 0 No
After investigation, and a hearing if required under Sec. 192 of th
have been made:
1. All the members-in-charge designated in the appli
character and have never been convicted of a c.' e
Signature of Person Conducting Investigation.
e
2. Applicant is a qualified authorized organization 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.
S. 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.
10. Other findings: (Specify)
Kl Yes DNa
[] Yes DNo
[] Yes DNo
KI Yes DNa
~Yes DNa
~Yes DNo
l[] Yes DNo
~Yes DNo
DYes DNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED r:z( i~cense is DENIED 0
Signature of ' r.
Filing date of Application June 17 th, 2008 Authorized Officer
Date ~\ 08' Title Town Clerk
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.GC.4 ~ev. 4/03) 11111111111111111111111111111 .-l
I
GC-5
--,
NYS RACING & W AGERINC BOARD
I Broadway Center. Suite 600
Schenectady. NY 12305-2553
Telephone (518) 395-5400 Fax (5] 8) 347-] 469
www.racing.state.ny.us
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE D
BELL JAR rn
RAFFLE D
GLLLILJ
J~'.
..-:-4.-.,.\
,..;.iI.~' ~.
;",
<i
c'
J'\i.L l"".~\-j.
GC - [lL] - GILGJ- GJQLJ-
N.Y.S. Identification Number
This License Must Be
Conspicuously Displayed
During Cond uct of Games
$1 25.00 II
Amount of Fee Paid Lessor's License Number
Address: 339 Route 82 City: Wappingers Falls
Entire net proceeds to be devoted to the following specific lawful purpose(s):
Charity. Educational. Patriotic & Youth
Names of Members in Charge
Zip Code: 12590
Peter Cassidy
Floyd Scholz
Wally Wych
William Scampoli
LICENSE PERIOD
DATE
1/1/08-12/31/08
DA Y OF WEEK
HOURS
TYPE(S) OF GAMES
RAFFLE DRA WING
DATE
DRAWING TIME DRAWING LOCATION
AMOUNT OF RAFFLE PRIZES (Cash or Merchandise Prizes
at Fan Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
$
NUMBER OF GAMES
EACH GAME (Starting Bank)
NUMBER OF WHEELS
EACH WHEEL
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
ST A TE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
I ssued by
Town of Wappinger
(Name of Municipality)
Authorized Officer)
11111111111111111111111111111 .J
July 21, 2008
(Date)
L B.J-GC-5 (Re\'. 3/06)
.,- .
GC-2
NYS RAC[NG & W AGER[NG BOARD
I Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (5[8) 347-1469
\vww. racing. state .ny. us
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE L
(Casino Nights, Bazaars, Carnivals) _/
BELL JAR M
RAFFLE 0
(only rames wI over $30,000 net profits in calendar year)
-,
~.r..;.~.~( ,
" ...
:;
",), ~
". 'l'I","IO'~ '
FOR OFFICE
USE ONLY
$1 25.00
Fees Received
------.--._"__.___..... .____,.' .__mu___.... '.__._ _ .
[ill / [ili] / [ili]
Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC - ITIIJ - [ITITI] - [ITili] - EIITIIill
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
Town of Wappinger Dutchess
Name of Municipality County
2. Address
u b
339 Route 82, Wappingers Falls,NY
3. Has applicant ever been denied a games of chance license? 0 Yes [>> 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 ~
Incorporated Association 0
State incorporated
New York
Date CD / IT] / [IKJ
Date CD / IT] / IT]
Unincorporated Association 0
State incorporated
Individual
o
5. Did your corporate status change since your identitication number was assigned? 0 Yes ~ No
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 to be conducted.
119 No I I' "yes", what is the trade name?
339 Route 82
Wappingers Falls,
NY 12590
8. Name and address of authorized games of
chance lessor renting to appl icant.
9. Does the applicant own the premises? IZl Yes 0 No If "yes", how long?
I O. Capacity for public assembly of premises presently owned or occupied.
250
II. Have premises been regularly used? ~ Yes 0 No If "yes", how long?
Are games of chance being played now on these premises or has it ever been? 0 Yes
1970
o No If "yes", give full details.
12. Are the premises or any part thereof
where games of chance are to be played
licensed by the State Liquor Authority?
I I' "yes", state Jhe tyge ~f Jicense an<lnumber.
lliYes 0 No o~083:~~B~tcfi~~~obF 5Ib~32
13. Has such license ever been
revoked or suspended? 0 Yes
[ZNo
If"yes", why'l (Explain on a separate sheet, if necessary, and attach.)
L BJ-GC-2 (Re,'. 3/06)
Page I 01'2
111111111 11111 "11111111""1 .J
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PART C. PURPOSES OF GAMES
14. Stale the specific purposes for which the entire net proceeds are to be devoted and in what manner.
charity, patriotic, youth, educational
I swear (or aflinn):
That ALL the attached Schedules are a material part hereofand are incorporated herein as ifset 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 a II 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 Ganles of Chance 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 tenns 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
of local licensing 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 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 professional services in an amount not exceeding that fixed by the Board.
rn/CEJ/~ I~/~
Date Signature ofl'fcad of OrganizatIOn
Peter J
Print Name
Cassidy
STATE OF NEW YORK }ss
COUNTY OF Dutchess
CITY rrOWNlV1 LLAGE OF Wappinger
Pe ter J. Cas s idy being duly sworn deposes and says that (s)hc 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.
Sworn to before me this /IM day of :]ZInG 20 08
Jv1t:{IY' /~n iLl-Chi-! 11/1/L.-
Notary Public
My Commission expires 5/2--1/; I 20
Signed
vf!MtJ~~(~
Commissioner of Deeds
Mary Ann Menuau
Notary Public, State of New York
No. 01 ME5078350
Qualified in Dutchess County
Commission Expires OS/2711 I
L BJ-GC-2 (Rev. 3/06)
Page 2 of2
1111111111111 ""1111111"111 --1
I.
GC-2A
I
NYS RACING & WAGERING BOARD
I Watervliel Ave. Ext.. Suite 2
Albany, NY 122Q6..1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
APPLICATION FOR GAMES OF CHANCE LICENSE
GC- m - 0Ij - EEG - @J2Iill
NYS Identification Number
SCHEDULE 1: OFFICERS AND DIRECTORS
LiSl names. addresses and dates of birth of nil officer.;.
If organization is a corporation. or an incorporated or unincorporated association. lisl officers and directors.
TITLE NAME DATE OF BIRTH STREET ADDRESS CITY
President I Peter J. Cassidy I~I ..Q:L/1965 I 51 Orchard Pl IHopewell Jdt
Treasurer I Floyd Scholz I~I ~/1952125 Clover Hill Ipoughkeeps~e
Secretary I Paul Taesatano I~I ~/19541338 Cary Road IFishkill I
Director I William Hunt I~I ~/19421109 Jackson St. IFishkill I
Director I Jerry Albanese I~I .1!!-/1957 I 52 Hemloclt Driv~Hopewell Jdt
Directorj Anthony Spaziani L.!}11 ..1..2-/1960167 Hidden Acres IStormville I
Director I Edward Mead 1~1 ~/1950141 Flintrock Rd~Fishkill I
I 1_1_1_1 I I
I 1_1_1_1 I I
I 1_1_1_' I I
I 1_1_1_1 I I
Attach additional sheet if necessary.
[I]/[D/[[]
Date
ZIP
12533
12603
12524
12524
12533
12582
12524
MEMBERS IN CHARGE OF GAl\.1ES
(MUST LIST AT LEAST FOUR MEMBERS OF APPUCANT ORGANIZATION)
DATE YEARS OF
NAME OF BIRTH tvIEMBERSHIP STREET ADDRESS
Peter Cassidy I 04 f 09 I 19651 21 I 51 Orchard Place
Floyd Scholz 1-08 I ~ I 19521 30 I 25 Clover Hill
Wally Wych 1-09 103 I 19541 15 1193 Old Sylvan
William Seampol~-U/~ I 19731 6 1162 White Pong
'-1-1-1 I
1=1=1=1 I
I 1 I_I I
'-I-I I I
'=1=1=1 I
SCHEDULE 2:
CITY ZIP
~opewell Jet 112533
I Poughkeepsie 112603
LakelHopewell JctJ12533
Rd. I Stormville 112582
I I
I I
I I
I I
I I
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF2 AUXILIARIES/AFFD..,lATES. EACH AUXILIARY/AFFILIATE LISTED MUST HAVE ITS OWN lD NUMBER.)
NAME OF AU~IARY/AFFILIATE GAIvffiS OF CHANCE ID NU:MBER
//11111/111111111111111111111 --1
L BJ.GC-2A (Rev.4/0J)
Page 10f2
I.
GC-2B
NYS RACING & WAGERING BOARD
1 Watervliet Ave. Ext.. Suite 2
Albany. NY 12206-1668
Telephone (518) 453-8460 Fax (5 J 8) 453-8492
www.racing.state.ny.us
APPLICA TION FOR GAMES OF
CHANCE LICENSE
--,
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~.- . -~-- .
..~~~nUlO~~-p.
GC-G2J-~-~-~
NYS Identification Number
[I]/[I]/[I]
Date
SCHEDULE 5 DA TES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPLICABLE FOR BELL JAR GAMES)
DATE HOURS RENT
,/~/, ,am /pm - ,am/pm!$ ,
.. . .- . ,.,
I~/, am / pm - am / pm ! $ ,
. . . . ,.,
I~/. ,am / pm - ,am/pm!$ ,
' , ,. . ,-,
I~/, ,am / pm - am/pm !$ ,
.. . '-0
I~/, ,am /pm - ,am/pm! $ ,
' , ,.,
, I , ,I . ,am Ipm - ,am/pm! $.
.. . I- .
I~/, ,am Ipm - ,am/pm!$ ,
. . . .
, I . , I , ,am Ipm - am I pm ! $ ,
.. . , . ,..
,/~/, am I pm - ,am/pm!$,
' , " '-0
I, I. am Ipm - am I pm 1$ .
' , ,.,
, I '---'---" I , am I pm - ,am/pm 1$.
. . , .
I~/, am I pm - ,am/pm !$,
. . ,-,
RAFFLES PRIZES (Cash or Fair Market
DATE TIME
Value of Merchandise)
I, I, I . am / pm - ,am Ipm !$, " "
I , I. . ,-,
I, I I am / pm - ,am / pm !$,
I . .. . ,. . '-0
I, /, I am I pm - am /pm !$,
I , .. . " '-0
I, I, I am / pm - am / pm !$.
' . . e. " '.0
I, I, I am I pm - am / pm !$
I , ,-, " .0
SCHEDULE 6 EXPENSES
List items of expense to be incurred, and the names and addresses of persons to be paid.
ITEM OF EXPENSE VENDOR NAME STREET ADDRESS CITY
STATE ZIP
L 8J.GC.2B (Rev. 4/03)
Page I of2
",IIIIIIIIIfIIlIIll,III,llll --1