Wappingers Elks Lodge (6)
r
GC~5
NYS RACING & WAGERING BOAIill
1 Broadway Center, Suite 600
Schenectady, NY J 2305-2553
Telephone (5]8) 395-5400 Fox (518) 347-1469
www.racing.state.ny.us
-,
LlCENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE KJ
BELL JAR 0
RAFFLE 0
GC ~ GLJ - GILl [iliTI - ITmJ
N.Y.S. identification Number
1\ J~ '~1:J" f:..
'~'''''.''.'' :..........';'1.1..'~."
, :~~ \ ...
': .
...~ ,',., ,,'l~.':'.:i:~,. .:'"
'. ">..,:..L1r+c~'~'" c:-
This License Must Be
Conspicuous})' Displayed
During Conduct of Games
~
Municipal License Number
The following organization:
$1 25 . 00 II
Amount of Fee Paid Lessor's License Number
Address: 1195 Rte. 376, City: Wappingers Falls
Entire net proceeds to be devoted to the following specific lawful purpose(s):
Zip Code: 12590
Names of Members in Charge
Paul Bader
Simon Kaufman
Lewis Hakim
Greg Sarno
LlCENSE PERlOD
DATE
02/05/10
DAY OF WEEK
HOURS
TYPE(S) OF GAMES
RAFFLE DRAWING
DATE
DRAWING TIME DRAWING LOCA T10N
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
$
NUMBER OF GAMES EACH GAME (Startmg Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE pRIZE
SHALL EXCEED $500.
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
EACH WHEEL
NUMBER OF WHEELS
GAMES SHALL BE PLAYED IN ACCORDANCE WITH "
ST ATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAWS.
Issued by Wappinger
(Name of Municipality)
Town8kfJ. ~. ....
,- Ie ~u. _ r)
.. .-
(Sjgnature of Authorized Officer)
- \\\\11\ 1\\\\\\\\\\\1\\\1\\\1\ --1
01/12/10
(Date)
L BJ-G~-5 (Re,'. 3/06)
JAN-4-2010
(845)298-1478
TO: 4522319
10:54A FROM:TOWN CLERK
r
GC-4
NYS RACING &. W AGERlNCl BOARD
I Watervliet Ave. Ext.. Suite 2
Albany. NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.raclng.SUlte.ny.UI
P.1/1
-,
FINDINGS AND
DETERMINATION
FOR GAMES OF CHANCE
LICENSE
GC-rn-~-~-~
N.Y.S.ldentification Number
Town of Wspt!inRer
Name of Municipality
Mumcipal Law. the following findings and detennlnations
rn'es 0 No
Name of Applicant Organization
1195 Rte. 376. Wsppin2ers Falls. NY 12590
Address
After investigation, and a hearing if required under Sec. 19
have been made:
I. All the members-in-charge designated in 1
characler and have never been convicted
Signature of Person Conducting Invcatigatio .
'5 her\~
2. Applicant is II qualified authorized organization as derIDed in the Games of Chance Ucensing Law.
3. Ali the members designated in the application to conduct games are bona tide active memberS of the applicant
organization.
4. The premises presently owned or occupied by the applicant are jn 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 devoled 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 Qames
of Chance Licensing Law and the Rules and Regulations of the H.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)
iI Yes ONo
!1 Yes DNa
at! Yes DNo
~Yes DNo
at! Yes DNo
!I Yes DNo
IlD Yes ONo
!I Yes CI No
CI Yes ClNo
TO BE COMPLETED BY MUNICIPAL CLERK:
As a resulL of the findings and determinations stated above. license is GRANTED~; license is DENIED CI
Signature of
Filing date of Application 12/31/09 Authorized Officer
ONE COpy OF THIS FORM TOGETHER WITH ONE COPY OF FORM GC-2, :lA, 2B MUST BE RECEIVED BY THE
N.Y.s. RACING AND WAGERING BOARD FIVE DAYS PRIOR TO THE FIRST AUTHORIZED UCENSR PERIOD.
L BJ-GC~ .....4103) .filD 1 1 mllll\O 1 .-J
Date
1- fa -10
Jnhn c. MAA~DTAn"
Title
Received Time Jan. 4. 2010 11:43AM No. 0208
TOWN CLERK
Chris Masterson
TOWN OF WAPPINGER
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
WWW.TOWNOFWAPPINGER.US
(845) 297-4158 - Main
(845) 297-5771 - Direct
(845) 298.]478 - Fax
TOWN SUPERVISOR
Christopher J. Colsey
~~::_-
Office of the Town Clerk
TOWN BOARD
William H. Beale
Vincent Bettina
lsmay Czamiecki
Joseph P. Paoloni
December 12, 2010
New York State Racing and Wagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject:
Games of Chance License- Wappinger Elks Lodge 2609
Please fmd enclosed the GC-2, GC-2A, GC-2B, GC-4, and GC-5 for the Wappinger
Elks Lodge 2609 for the year of 2010.
JCMlcf
enc.
r
. GC-2A APPLICaTION FOR GAMES OF CHANCE LICENSE
NYS RACING & WAGERING BOARD
] Watervliet Ave. EXl.. Suite 2
Albany, NY 12206-1668
I 'Telephone (5] 8) 453-8460 Fax (518) 453-8492
www.racing.sLate.ny.us
-,
Name 0 Organization
GC- ~ - [ilili] - ~ - ~
NYS Identification Number
~CHEDULE 1: OFFICERS AND DIRECTORS
~ist names. addresses and dates of birth of all officers.
f organization is a corporation. OT an incorpo[lltcd OT unincorporatedassociatioll, Iisl officers and directors.
. TITLE NAME DATE OF BlRTH STREET ADDRESS
I 1---1---1---1
I 1---1 ___I_I
I 1_1---1_1
I I_I ___1_'
I 1_1---1_1
"1 I_I ---I ~ I
I 1_1_1_1
I 1_1---1_1
I 1---1---1_1
I 1_1---1_'
1 1_1---1_1
Attach additional sheet if necessary.
GG]/W/GJ]
Date
CITY ZJP
I .f I
I \
I I
I I
1 I
I I
I I
I \
\ I
I I
I I
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
Paul Bader 1_1_1_1 I. I
I 91 20 I 1965 I 14 I 134 Anderews Rd I laGrange 12540
Simon Kaufman I 8 / 16 I 1930 I 7 I 9 S. View Ln I Hopewell Jet 12533
Lewis Hakim I--II .-2.7-1 ~I e I 26 QY88R MAe Ln I }'\Iappingp-~ F::allc: 125go
Greg Sarno I 7 I 01 1 19361 ?R I 1 ~ n::an~ PI~~ I W~ppir:lg'iilJ:[ FailE: 12600
1=1='1=1 1 I
1_1_1_1 I I
1_1_1_1 I I
1_1_/_' I I
SCHEDULE 3: AUXILIARY/A.FFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXiMUM OF2 AUXlLIARIES/AFFll..IATES. EACH AUXll..IARY/AFFILlATELlSTED MUST HAVE ITS OWN JD NUMBER.)
NAME OF A UXlLIAR Y /.1.\FFlLIA TE
GAMES OF CHANCE ID NUMBER
.IIIIIIIIIIIIIIHlllUl II \1\ II -1
llJ.GC.2A (Rev. 4/()3)
Page 1 of2
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 Haekensack 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 Fishklll 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 09/15/1957
Harris C. . Jones 217 Brothers Road Stormville 18 04/2411944
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 F:alls 28 07/01/1936. . .'~ rf i
Kenneth J. Tucker 34 Pawling Lake Pawling 9 -.' .
" "
Robert N. Wallner 7 Kinry Road Poughkeepsie 19 01/17/1933.
",
", "
"
r
GC-2
I
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
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE ~
(Casino Nights, Bazaars, Carnivals) .
BELL JAR D
RAFFLE D
(only raffies wi over $30,000 net profits in calendar year)
$1 25.00 I [cl]/rn/GLJ I
Fees Received Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC- [lliJ- cmJY]-lrol DIZI- ~
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
TDv..J r0 c:r-f UJltf{)tt/~s 1) ~
Name of Municipality - ~ f County
FOR OFFICE
USE ONLY
1.
2. Address
3.
DYes DNo
4. Check type of organization and, if applicable, give the State and date of incorporation.
Corporation D J ~
'0'" State incorporated _ E W 01Z../ c::
Incorporated Association """
Date I V ~ I [Q[2] I [mJ
Date CD I CD I CD
Unincorporated Association D
State incorporated
Individual
D
5. Did your corporate status change since your identification number was assigned? DYes D No
6. Are you doing business under a trade name? DYes []eNo 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. II CJS'R..7c 3" b Wttff FI, ~ Y 12S'90
8. Name and address of authorized games of
chance lessor renting to applicant.
,vi)
9. Does the applicant own the premises? ~Yes 0 No If "yes", how long?
10. Capacity for public assembly of premises presently owned or occupied.
;)./6' to
II. Have premises been regularly used? i1. Yes D No If "yes", how long? .1? if;~
Are games of chance being played now on these premises or has it ever been? ~Y es No If "yes", give full details.
Fe..-e:. RU~ S- b~~..,6C(' II} :,J. SO 11<>-
. :;.,01 00 .
12. Are the prerruses or any part thereo If"yes", state the type ofhcense and number.
,;here games of chan~ are to be pl~yed !XI Yes D No C L - 0 00 - 7 t/ ~ '-13
hcensed by the State LIquor Authonty?
13. Has such license ever been If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
revoked or suspended? DYes IKI No
L BJ-GC-2 (Rev. 3/06)
Page I of2
III II 1111 I III 1 111111111111111 ..J
r I
PART C. PURPOSES OF GAMES
14. State the specific purposes for which the entire net proceeds are to be devoted and in what manner.
1/ '3 C. fl-ftl~ l T If )3 l ~ )../ '3 D po.).. ().. 71 J}'\ S
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 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 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 of the N.Y.S. Racing & Wagering Board and with the provisions
ofIocallicensing 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.
[iliJ1 WQJ 10iJ 9 '=".-C'_
Date Signature of Head of Organization
C}
P .\tP'4.
Print Name
~.. ~/c
STATE
OF NEW YORK
TONY CURRY
Notary Public - State of New York
SS 10 No. 01CU6194029
Qualified in Dutchess County 2AJ L'
My Commission Expires September 29. _ ~
COUNTY
OF~S
OF G,kl;\ \
CITY /TOWNNILLAGE
A being duly sworn deposes and says that (s)he is the person above named,
that (s) as 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 ~ 0 day of t> "'-II\I~~( Signed
~\(#r:~Publi'
My Commission expires ~~~~. 2..J1, 20 ) 2---
L BJ-GC-2 (Rev. 3/06)
Page 2 of2
11111111111111111111111111111 -.J
r'
. GC-2A
-,
NYS RACING & WAGERING BOARD
1 Watervliet Ave. EXL, Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-8492
www.racing.state.ny.us
APPLICATION FOR GAMES OF CHANCE LICENSE
GG]/Q]/GQ
Date
CITY ZIP
I .,'
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
"1
I
I
I
I
I
SCHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DAlE YEARS OF
NAME OF BIRTH MEMBERSHIP STREET ADDRESS CITY ZIP
1_/_1_1 I I
Paul Bader I 91 20 1 1965 I 14 I 134 Anderews Rd I laGrange 12540
Simon Kaufman 1---;/-:;6 I~I 7 I 9 S. View Ln I Hope\Wll Jet 12533
Lewis Hakim I 71 .-2L/~1 R I 26 Q1:I99R .\RRe Ln I )Nappil"\gf!~ I=:::all<: 1~go
Greg Sarno I 7 / 01 1 19361 ?8 I 1 ~ n:::an:::a PlilC9 \ ,^'''pping'i~ f:aIlE 12699
-1-/- I I
1___1
1_/_/_1 I I
/_/_/_1 I I
1_/_/_1 I I
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXiMUM OF2 AUXll...IARIES/AFFll..IATES. EACH AUXll..IARY/AFFILlATE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXILIARY/.AFFILIATE
GAMES OF CHANCE ill NUMBER
, 1111111111111111\ 111I11111111 --3
llJ-GC-2A (Rev. 4/03)
Page 1 of2
. r- SCHEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE OF GAMES , I
LiSlall 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 orl\lUlization or affiliate for at least I year,
YEARS OF
MEMBER NAME DATE OF BIRTH :MEMBERSHlP STREET ADDRESS CITY ZIP
Sfl4./~~usll_/ _/ _ I _ I I
I / / I_I I
1-/-/-1_1 ,
1-/-/-1_1 I
1=/=/= _ I "
I / / _I
1-/-/-1_1 I
1-/-/-1- I
I~/-/-I_ I
1-/-/-'-' 1
/-/-/-,_, I
1-/-/-'_1 I
'-/-/-1_' I
'-/-/-1_1 ,
'-/-/-1_1 I
1-/-/-1_' I
'-/-/-1_' ,I
'=/=/=1_1 I
1 / 1 , i ii,' I
I=/=I=! = Ii I
I / 1 I ! . I
1-/-/-'=1 ,
1-/-/-1_1 I
1-/-/-1_1 I
'-/-/-1_1 1
1-/-/-1_1 1
1-/-/-1_' I
'-/-/-1_1 I
/-/-/-,_, I
1-/-/-1_' 1
'-/-/-1_1 I
1-/-/-'_' I
1=/=/=1_1 I
1_/_/_1_1 1
L BJ.GC.2A (Rev, 4/03)
Attach additional sheet if necessary,
Page 2 of 2
111111111111 11111 " III UIIII --.J
~.,
Schedule 1: Officers and Directors
~OD'1 '" ~~~
WAPPINGER LODGE #2609 OFFICERS for 21fi- If.8>
Title
Name
----..-------------- ------------- -- -------------------------.. --------------- .-.- ------.---..
Address
Exalted Ruler
Leading Kgn
LoyalKgn
Lect. Kgn.
Esquire
Chaplain
Inner Guard
Secretary
Treasurer
Tiler
Trustee
Trustee
Trustee
Trustee
Trustee
Joseph P. Havelka Sr.
Eileen E. Boyer
Diana Cole
Paul Bader
Mark H. Fox
Catherine Rohling
Rosemarie Perretta
Robert M. Acquanita
Pamela S. Kultsar
Susan Dorler
James Boyer
Rocco Valente
Alex Czarnieckl
Alfred DeRose
Vacant
38 Hickory Lane
134 Andrews Road
P.O. Box 549
. 134 Andrewfi Road
28 Tiger Road
54 Brothers Road
35 Cathy Road
10 Vorndran Dr.
58 Hillis Terrace
21 Valley Road
134 Andrews Road
61 Flshklll Hook Rd.
31 Hele,n Drive
25 Hickory Lane
No Officer receives compensation of any kind.
Town Zip DOB
------------------------------ -..-------- --------------------
Pawling 12564 11/13/1942
Lagrangevllle 12540 01102/1943
Hughsonvllle 12537 04/25/1948
Lagrangevllle 12540 09/20/1965
Hopewell Jet. 12533 09/15/1957
Wappinger Falls 12590 04/22/1940
Poughkeepsie 12603 08/07/1943
Wappinger Falls 12590 OS/25/1942
Poughkeepsie 12603 02/01/1950
Wappinger Falls 12590 03/29/1939
Lagrangevllle 12540 11/28/1937
Hopewell Jet. 12533 06/06/1941
Wappinger Falls 12590 10/16/1941
Pawling 12564 11/28/1961
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 04/24/1940
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 Wappingers Falls 28 06/07/1926
Mark H. Fox 28 Tiger Road Hopewell Jct. 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 :'r ,
Kenneth J. Tucker 34 Pawling lake Pawling 9
Robert N. Wallner 7 Kinry Road Poughkeepsie 19 01/17/1933
r
GC-2B APPLICATION FOR GAMES OF
NYS RACING" WAGERING BOARD . CHANCE LICENSE
1 WaterVlIet Ave. Exto, Suite 2
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453.8492
www.racing.ltare.ny.us
-,
GC- [ill - QIill] - [Hilid - ~ [llil! [ill! [ill]
NYS Identification Number Date
SCHEDULE 5 DATES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPUCABLE FOR BELL JAR. GAMES>
DATE HOURS
.~ .1./, O.~ /.) .O.! ll:.O.D ,am@- . I :>...:.D. c) .eiiii)pm!$.
.I . ./. .! . .:. ,am/pm - :: .am/pm!$,
,I,' ./. .! . .:. ,am/pm - . ,:. ,am/pm!$.
I . ,I. ,I. .!. ,:. ,am/pm - . ,:. ,am/pm!$
./ ,I. .! . ,:. ,am/pm - . ::. .am/pm!$.
I . ,/ ./. ,! . .:. ,am/pm - .. .:. .am/pm.!$.
L . ,/. ./ , .! . .: .am/pm - . .:. ,am/pm!$.
. J ./. ! ,:. ,am/pm - . .:. .am/pm!$.
,J. ./. ,!. ... ,am/pm-. .:. .am/pm!$.
.J. ./. .!. .:. .am/pm-. ... .am/pm!$.
,I. ./. .! . ,.. .am/pm - . .:. .am/pm!$
~ / ./. ,! . ,.. .am/pm - . .:. ,am/pm.!$.
RAFFLES
DATE
RENT
... .
. .
.. .
.. .
.. .
.. .
.. .
.'
I. .
.. .
.. .
, .
TIME
PRIZES (Cash or Fair Market
Value of Merchandise)
.am /pm ! $ ... .....
,am/pm '$.. ,. ... .
,am/pm !$. ...
,am/pm \$. ,..
,am/pm !$. ..
./
.J
./
./
./
I
.1 .
I
. f .
I
. I .
I
. I .
I
. -0.
.am/pm -
,am/pm - .
am/pm -
.. ..
am/pm -
.. a
am/pm -
.
.
.. ..
./
./
./
.f
./,
SCHEDULE 6 EXPENSES
List items of expense to be incurred, and the names and addresses of persons to be paid.
ITEM OF EXPENSE VENDORNAME STREET ADDRESS CITY STATE ZIP
t ~j:). ~ of- I; ('1JA'o. S i !".~n:xft ,J'Q eo 1/2..A. I m: ~ 0) l. lkflj(", 1/ s ~ / 'z- {;'9u
DO(":). ~I/< LOD~J(P() 9 /l9~ 1.737(,0 I,;JA-pI ~A-Ik 4 12~r\)
.
. .
.
.i. ..
.
..
.
, .
... .
.
.. ..
.
, .
.
I. .
. I ..
L BJ-GC.2B (Rev. 4/03)
Page 1 of2
~I\l\\ II \l \ll~ \1111111111 ..J
I
!
r
,
f
!
1
r
I
1
f
;
f
r
I
I
1
I
i
~
I
!
l
f
I
I
I
r
I
!
I
t
\
t
.
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 Vef!8S Nif!hts and Bazaars onlv: 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)
4 cJL-
ICE
For Merchandise Wheels, Bell Jars and Raftles, 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:
INDICATE IF THIS APPLICATION
IS FOR A BELL JAR
LICENSE
YESD NO 0
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BELL JAR DEAL SHALL NOT
EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500
RAFFLES:
INDICATE IF THIS APPLICATION
IS FOR A RAFFLE
LICENSE
YESD 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. 3/06)
Page 2 of2
11~1111111I111~llIn III ..J
"
~OLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK .",.,
~.~,,,,,,,"1""'"
.
I~~.
HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK
~~~ 6~~2 1403181703
:;
0807094
12/30/2009
>
~ WACHOVIA
Ol
'"
"-
3 Pay To The
Order Of
"""Town Of Wappingers"*****
$
$25.00
:0
...
...
D
n *TWENTY FIVE DOLLARS AND 00 CENTS
""*"DIana Cole"""""*""
Remitter l,VJ) ff j'jJ'{ f {Kr,. Lo ~ $f- ft d ~ t> 'I
Dollars
Wachovia Bank, National Association
tD '"'''''',
h',IIW..,
t Llti.li.b 0"
tldtk
----_._--------~
III * ~ 0 :3 * B * 7 0 :3111 I: 2 b * * 70 0 2 51: 5 0 7 g gOOD 0 0 B g :3 III
.
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
December 31, 2009
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, NY 12601
Dear Sheriff Anderson:
Enclosed, please fmd a copy of the members of the Wappinger Elks #2609,
Route 376, Town of Wappinger, who will be conducting Games of Chance
on February 05,2010.
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,
~c~
C. asters on
Town Clerk
JCM/cf
Enc.