Wappinger Elks Lodge (2)
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
February 11th, 2008
New York State Racing and .Wagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject:
BELL JAR LICENSE - Wappinger Elks #2609 - 2008
Please fmd enclosed the GC-2, GC-2A, GC-2B, GC-4, and GC-5 for the Wappinger
Elks #2609 for the year of 2008.
JCM/dm
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
February 11th, 2008
Wappingers Elks #2609
1195 Route 376
Wappingers Falls, NY 12590
Dear Ms. Mills:
Please find the attached Bell Jar "License to Conduct Games of
Chance" for the year 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,
JCM/dm
--,
r
GC-5
NYS RAC]NC & W AGERlNCl BOARD
1 Broadway Ct:nter, Suite 600
Schenectady, NY ]2305-2553
Telephone (518) 395-5400 Fax (5\8) 347-1469
wlwl,racing.statc.ny. us
LlCENSE TO CONDUCT
GAMES OF CHANCE
]'LEASE CHECK
GAMES OF CHANCE 0
BELL ,]AR []I
RAFFLE 0
GC - [iJlJ - ~- [ililiJ- ~
N.Y.S. Identification Number
.fl.i
'."J.ili"';/J.
}~'j
.1
'l-XI:~i l.~lt1~;: ,;,":.( .r.P-~
This License Must Be
Conspicuousl)' Displayed
During Conduct of Games
$1 25 . 00 ] [ l
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):
Zip Code: 12590
Names of Members in Charge
Joan Mills
Derrick Mills
Pam Kultsar
Dana Mills
LICENSE PERIOD
DATE
DAY OF WEEK
HOURS
TYPE(S) OF GAMES
Year 2008
RAFFLE DRAWING
DATE
DRAWING TIME DRA WING LOCA TI ON
AMOUNT OF RAFFLE PRIZES (Cash or Merchandise Prizes
at FaIr Market Value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
$
EACH GAME (Start1l1g Bank)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
NUMBER OF WHEELS EACH WHEEL
GAMES SHALL BE PLAYED IN ACCORDANCE WITH
STATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
NUMBER OF GAMES
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500.
1 ssued by
'T'm.m nf \J::1rT'in~p,.
(Name of Municipality)
February 11, 2008
(Date)
Authorized Officer)
111111\ 11111\11111\11\ \ 111\1\ --1
L B.J-GC-5 (Re\'. 3/06)
--,
FINDINGS AND
DETERMINA TION
FOR GAMES OF CHANCE
LICENSE
r
GC-4
NYS RACING & WAGERING BOARD
1 WatervJiet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
GC - GLJ - GIiliJ - [iliLJ-lliGhIJ
N.Y.S. Identification Number
Name of Municipality
. 1195 Rou t e
Address
NY 12590
w, the following findings and detenninations
After investigation, and a hearing if required under Sec. 192 0
have been made:
1. All the members-in-charge designated in the applica
character and have never been convicted of a 1
Signature of Person Conducting Investig 'ition'
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.
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 ofthe N.Y.S. Racing and Wagering Board, and local ordinances.
6. The entire net proceeds are to be devoted exc1usively 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)
/ ~es DNo
GO Yes DNa
~Yes DNo
!XI Yes DNo
IX! Yes DNa
IX! Yes DNo
rn Yes DNo
IX! Yes DNa
DO Yes DNo
DYes DNo
-
TO BE COMPLETED BY MUNICIPAL CLERK: /
As a result of the findings and determinations stated above, license is GRANTED rzf; license is DENIED 0
Signature of ~
Filing date of Application February 4, 2008 Authorized Officer d.~->
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 .'-GC-4 en". 4ro3) 1111111111111111111111111111\ ~
Date
d\\\ U~
Title Town Clerk
I
r
GC-2
NYS RACING & W AGERlNG BOARD
I Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (518) 347-1469
www.racing.state.ny.us
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE 0
~i~trl~azaars, Carnivals) ~
~
..'
RAFFLE 0
(only raffles wi over $30,000 net profits in calendar year)
FOR OFFICE
USE ONLY
$\ JS,oD
Fees Received
\ 0\ 0.-\ I @B] I \0\0\
Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC_rn-ITILBJ-lLo1olzl-10\zIOI,13\
N.Y.S. Identification Number
_--:_ ~T IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENT\IN THIS APPLICATION
'CU-~'I Or; ,,*=\T:Jpir~"f":v":::> ..<1 \D1:d'r~J
Name of Municipality I County
PART A. GENERAL
I. Name of Or anization
ELK-:J
2. Wo Pr'-:>l tYjf"J'" E I h N'1
3. Has applicant ever been denied a games of chance license? 0 Yes qtNo 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
State incorporated
Incorporated Association 0
Unincorporated Association 0
State incorporated
Date 0] I 0] 10]
Date 0] I 0] I 0]
Individual
o
5. Did your corporate status change since your identification number was assigned? 0 Yes 0 No
6. Are you doing business under a trade name? 0 Yes 0iio If "yes", what is the trade name?
PART B. LOCATION OF GAMES
7. Address where games, bell jar, or raffle drawing(s) are to be conducted. I L q~) l~-L1f:3l c..,
8. Name and address of authorized games of " "I' 0-
chance lessor renting to applicant. --'.
9. Does the applicant own the premises? rj.. Yes 0 No If"yes", how long?
10. Capacity for public assembly of premises presently owned or occupied.
II. Have premises been regularly used'?)ll Yes 0 No If "yes", how long?
Are games of chance being played now on these premises or has it ever been?tS;tYes 0 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?
~Yes ONo
If "yes", state the type of license and number.
13. Has such license ever been 0
revoked or suspended? Yes
~NO
If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
L BJ-GC-2 (Rev. 3/06)
Page lof2
1\1111'" 111111111\\11 , \I '"' --1
r
PART C. PURPOSES OF GAMES
14. State the specific purposes for which the entire net proceeds are to be devoted and in what manner.
C-\-c::\\./ I . -:..::> j .
I
I swear (or affirm):
I. That ALL the attached Schedules are a material part hereof 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 ofthe 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 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 ofthe Games of Chance Licensing Law, the Rules and Regulations ofthe 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.
@J] I UE 15B10i/VlA~
Date Signature of Head of Organization
~rnct~ ~L lb.
Prmt Name
STATE
OF
NEW YORK
}ss
O~~+c... k t.. ca s
OF _f ~ \.4.1 \ ,.,... ,
'\L ~ l ~~ . \ \ being duly sworn deposes and says that (s)he is the person above named,
that (s e has read the foregoing s atement and the answer therein noted, and that such answers are true and that (s)he has personally
:~:: t::::::: :~t:~ ro thi"ffi::i:r h \, , 20 ~ Sign,d L ~
COUNTY
CITY ITOWNN1LLAGE
Commissioner of Deeds MAUREEN MASON .
Notary Public State ot New YorK
No ~\bI6c::,4()
Qualitied in County
Commission 3020{J1.
Notary Public
My Commission expires
20
L BJ-GC-2 (Rev. 3/06)
Page 2 of2
11111111111111111111111111111 .J
WAPPINGER LODGE #2609 OFFICERS for 2007-2008
Name Address Town b)Title
--------------- ---------------- ------------------------------ -------------------- ---------- -------------
Derrick Mills Pawling Lake Box 17 Pawling NY 12564 Exalted Ruler
Sandra Seekamp 67 Pawling Lake Pawling NY 12564 Lead. Kgn
Mark H. Fox 28 Tiger Road Hopewell Jct. NY 12533 LoyalKgn
Eileen Boyer 134 Andrews Road LaGrangeville NY 12540 Lect. Kgn
Catherine Rohling 54 Brothers Road Wappinger Falls NY 12590 Chaplain
Kenneth Tucker 27 David Lane Pawling NY 12564 Inner Guard
Robert M. Acquanita 10 Vorndran Dr. Wappinger Falls NY 12590 Secretary
Pamela Kultsar 58 Hillis Terrace poughkeepsie NY 12603 Treasurer
Susan Dorler 21 Valley Road Wappinger Falls NY 12590 Tiler
James R. Boyer 134 Andrews Road LaGrangeville NY 12540 Trustee
Alan Schrock 85 Hillis Terrace poughkeepsie NY 12603 Trustee
Rocco Valente 61 Fishkill Hook Rd. Hopewell Jct. NY 12533 Trustee
Joseph McDowell 127 Innis Ave. poughkeepsie NY 12601 Trustee
Dana Mills 17 Pawling Lake Pawling NY 12564 Trustee
I
r
GC-2A
APPLICATION FOR GAMES OF CHANCE LICENSE
,
.,.
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
[QLJ 1 curu 1 \C)\C.\
Date
v' ~l T -p j N L') E
Name of Organization
GC- [ill] - [b[illJ - [(ole)! 2-\-\0 \2.10 Ii 13\
NYS Identification Number
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
EK frr 1--1;\6 I iC> I 6 1)i6 i If CdINj,"l lote I tlWi mq
.)(L:k~l ''-- - -" ''If 1_1_1_1 1
1_1_1_1 I
~~~\
~/ I I I
C._____ ' - I
1 I
\=1=1=1
1_1_1_1
Attach additional sheet if necessary.
ZIP
I r' t
I 12:X..l-
1
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
__b-eJfY:l. \--.\\ \ \-'~ 1 2 1 10 1 '.:llJ.Lf I, ~-"'}]CYt-i ~nf-'\
_, ~X) \--\ 1\\ . \ .LL 1 ~ 1 ~ \ '? \ n ~\J\j I W~i UJ rc
-'n'''\' ~ \---t \ \ t.~ II XL 1 f2-1 LiO I l.D \ ["} ~)V~ \ lI-q to tc~'
\ .'\1., Ku\ -\"':~;() v I _I _I _I \3.8 H-t \ k::J kY"rUce
II 1 1 \ 1
1=1=1=1 \
11_/_/_1 1
'I 1 1 1 \
1=1=/='1, I
CITY ZIP
1"--7
I rCrV\J\ 1)-)('.1- i 2t=.x..)~
\ -Jt) w t 1 rq \ I I 25C,'i-
\ RJ V'\J I \ l-.ct \ ) ZL+-L
II1Dslh~):)It'; \ i Ad)::<'
1 1
1
1
!
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 AUXILIARIES/AFFILIATES EACH AUXILIARY/ AFFILIATE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXILIARY/AFFILIATE
GAMES OF CHANCE lD NUMBER
11111111111111111111111111111 .J
L BJ-GC-2A (Rev. 3/06)
Page 10f2
r SCHEDULE 4: ASSIST ANTS TO MEMBERS IN CHARGE OF GAMES """1
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 1 year.
YEARS OF
MEMBER NAME DATE OF BIRTH MEMBERSHIP STREET ADDRESS
\ I I \ \
\I~/~/- \ \
I~/~/- \ \
\~/~/- 1 \
\~/~/- \ I
I~/~/- \
I~~-
I I I I[ \
I~/~/-I-l
\~/~/- \ -I,
1~/~/- \ - \
I~/~/- \ - I
I~~_ _I
'II I I \ \
I,~/~/-I II
\~/~/- \-1
\-/~/- \ - \
II~/~/- I I
_~_ I
I I \ \
I~/~/- I I
l~~_l I
'II~I ~/_ II i
II I I \
I~/~/- \
\~/~/-
1~/~/- \
I!~/~/- \
\~/~/- \
I~/~/- \
I~/~/- \
1~/~/- II
\~/~/- 'I
I~/~/-- \
1_--
II I I \
I\~/~/- \
I\~/~/-- II
\~/~/- III
CITY
ZIP
i
I
I
I
I
I
\
_\
I
_I
_I
\
\
\
I
\
I
I
L BJ-GC-2A (Rev. 3/06)
Attach additional sheet if necessary.
Page 20f2
\\1\ \\ " \ \\1\1\11111111111111 .J
"
GC-2B
I
NYS RACING & WAGERING BOARD
I Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (518) 347-1469
www.racing.state.ny.us
Name of Organization - - . . . . - - . -
APPLICATION FOR GAMES OF
CHANCE LICENSE
GC- [ill] - [2lifi] -\[0\0 \2\-\0\2 b \ \ 13\
NYS Identification Number
rn I U@ I \0\<0\
Date
SCHEDULE 5 DATES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPLICABLE FOR BELL JAR GAMES)
DATE HOURS RENT
, / . ,/ ,am / pm - ,am / pm $.
. ,. . ,- . ,- .
, / . ,/ ,am / pm - am / pm $.
. ,. . ,- . , ,. ,
" / . ./ ,am / pm - ,am / pm $.
. ,. , ,- . ,- .
~ / ./ ,am / pm - .am / pm $.
. ," ,- . ,- .
./ ./ ,am / pm - ,am / pm $.
, ' ,. . ,- .
, / . ,/ ,am / pm - ,am / pm $.
. ,- . ,. . ,. .
./. ' / . ,am / pm - ,am / pm $.
0- . ," ,- .
./. , / , ,am / pm - ,am / pm $.
~ . . ,- . ,. ,
,/ , / . ,am / pm - ,am / pm $.
. ,. ... ,. . ,- .
. / . ,/ , ,am / pm - ,am / pm $.
,- , ,- . ,- .
, / . ,/ . ,am / pm - am / pm $.
,. L.... ,- . , ,- .
./ ' / . ,am / pm - ,am / pm $.
.- . I- I- .
RAFFLES PRIZES (Cash or Fair Market
DATE TIME
Value of Merchandise)
. / / ' am / pm - am / pm $. .., ,'. .
,- . ,- . ,
/ / ' am / pm - am / pm $.
0 " , , ,- . ,- . , ,- .
~ / / ,am / pm - am / pm $.
. , ,- . ,- . , ,- .
/ / ' am / pm - am / pm $
, . ,- . ," , "
. / / am / pm - am / pm $
. ,- . I- I ,- .
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 BJ-GC-2B (Rev. 3/06)
Page 10f2
11111\1\1111111\11\1111111111 --3
r~CHEDULE7 TYPES OF GAMES -,
List all of the single types of games to be conducted at all license periods enumerated in Schedule 5.
Note for Ve2.as Ni2.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)
LIST THE MAXIMUM AMOUNT OF PRIZES
TO BE AWARDED FOR EACH TYPE OF
GAME OF CHANCE (GAME BANK)
at $
at $
at $
at $
at $
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
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
LlCEN~
YES~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
$1 00,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L BJ-GC-2B (Rev. 3/06)
Page 20f2
1\1\11\ \ 11111 \ 1\\\\\ III \\ 1\1\ .J
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
February 4th, 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 Wappinger Elks
#2609,1195 Route 376, 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,
9!~
Town Clerk