Knights of Columbus
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
January 4, 2009
New York State Racing and Wagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject:
BELL JAR LICENSE - Knights of Columbus #1646 - 2010
Please fmd enclosed the GC-2, GC-2A, GC-2B, GC-4, and GC-5 for the Knights of
Columbus #1646 for the year of 2010.
hn C. Masterson
own Clerk
Town of Wappinger
r
GC-5
-,
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE 0
BELL JAR ~
RAFFLE 0
GC-rn-~-!iliLJ- ~
N.Y.S.ldentification Number
NYS RACING & WAGERING BOARD
1 Broadway Center. Suite 600
Schenectady, NY 12305-2553
Telephone (5]8) 395-5400 Fax (518) 347-]469
www.racing.state.ny.us
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This License Must Be
Conspicuously Displayed
During Conduct of Games
$1 $25.00 II
Amount of Fee Paid Lessor's License Number
Address: 2 F.:'Il'lt" M::dn ~t",."''''t" City: Wappin~erH Fall F;
Entire net proceeds to be devoted to the following specific lawful purpose(s):
Zip Code: 17"Qn
Names of Members in Charge
James O'Conner
John GormAn
John Simons
Max Dao
LICENSE PERIOD
DATE
DAY OF WEEK
HOURS
TYPE(S) OF GAMES
2010
RAFFLE DRAWING
DATE
DRAWING TIME DRAWING LOCA nON
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
$
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH MERCHANDISE WHEEL
$
NUMBER OF GAMES
EACH GAME (Stanmg 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.
Issued by Town of Wappinger
(Name of Municipality)
'I'l.Jnn r.l",,.k
(Title of Authorized Officer)
(Date)
Signature of Authorized Officer)
11111111111111111111111111111 -1
12/09/99
L BJ-G~-5 (Rev. 3/06)
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GC.4
NYS RACING & WAGERING BOARD
1 Warervliet Ave. Ext.. Suile 2
Albany, NY 12206-1668
Telephone (518) 453.8460 Fax (518) 453.8492
www.racing.state.ny.us
I
FINDINGS AND
DETERMINATION
FORGAMrnS OF CHANCE
LICENSE
GC - GLJ- [l]LW - ~- ~
N.Y.S. Identification Number
Town of Wappinger
Name of Municipality
2 East Main Street. WapDin~ers Falls. NY
Address
nic' al Law, the folIowing findings and determinations
After investigation, and a hearing if required under Sec. 1
have been made:
1. All the members-in-charge designated in the a
character and have never been convicted of c
Signature of Person Conducting Investigation
ce are of good moral
Title
2. Applicant is a qualified authorized org nizat n 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 Tent to be paid to an authorized games of chance lessor is reasonable.
10. Other findings: (Specify)
DYes DNo
IKI Yes DNo
IlO Yes DNo
E!Yes DNo
IKI Yes ONo
IKI Yes ONo
IKI Yes ONo
tiC Yes ONo
gg Yes DNo
DYes ONo
TO BE COMPLETED BY MUNICIPAL CLERK: ./
As a result of the findings and determinations stated above, license is GRANTED ra;"license is DENIED 0
Signature of
Filing date of Application 11-30-09 Authorized Officer
Date I \ t.\ \ ~( 0 Title Town C,1 prk
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-GC4 (Rev. 4/03) 11111111111111111111111111111 ..J
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GC-2
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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
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE D
(Casino Nights, Bazaars, Carnivals)
BELL JAR ~
RAFFLE 0
(only raffles wI over $30,000 net profits in calendar year)
$1 7.5.00 I G:IJ / GJJ / C;J~rm I
Fees Received Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
GC-[]IJ-~-~- ~
N.Y.S. Identification Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN 'JIS APPLICATION
?#aJAJ tJ? idg;?,t1/p6-f/l / u7L..#~
Name of Municipality County
PART A, GENERAL
1. Name of Or anization
FOR OFFICE
USE ONLY
2. Address
3. Has applicant ever been denied a games of chance license?
4. Check type of organization and, if applicable, give the State and date of incorporation.
Corporation 0
State incorporated
Incorporated Association 0
Date CD / CD / CD
Date CD / CD / CD
Unincorporated Association 0
State incorporated
Individual
o
5. Did your corporate status change since your identification number was assigned? DYes 0 No
6. Are you doing business under a trade name? DYes % No 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. eX EA.Jr /l1f/~ 51j V/" A/( Ai ~O
8. Name and address of authorized games of
chance lessor renting to applicant.
/l/J:t
,
9. Does the applicant own the premises? )XYes 0 No If "yes", how long? YI"
I O. Capacity for public assembly of premises presently owned or occupied. .3 If
II. Have premises been regularly used? ~Y es 0 No If "yes", how long?
Are games of chance being played now on these premises or has it ever been? 0 Yes 0 No If "yes", give full details.
12. Are the premises or any part thereof
where games of chance are to be played J1f Yes 0 No
licensed by the State Liquor Authority?
If "yes", state the type of license and number.
U. 5'1 ~'I'3
13. Has such license ever been
revoked or suspended? 0 Yes
DNo
If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
L BJ-GC-2 (Rev. 3/06)
Page 1 of2
11111111111I111I1111111111111 -.J
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PART C. PURPOSES OF GAMES
14. State the specific purposes for which the entire net proceeds are to be devoted and in what manner.
I swear (or affirm):
1. 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 ofthe 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 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]J / 12-171 / [ili]
Date
~~.
MAiTkl:,"1.,) J. f{O~T'LlJIll/l
Print Name
STATE
OF
NEW YORK
ss
COUNTY
OF )cJ]-cf~j
OF !J)ftiPIN 6({l~ iffGLS
CITY rrOWNNILLAGE
;., ri lJA...,t.c) being duly sworn deposes and says that.(l)he is the person above named,
t t (* he has read the foregoing statement and the answer therein noted, and that such answers are true and that ")he has personally
affixed his 9-) signature to this affidavit.
Sworn to before me this of 7 day of AI,lJr>(4n... , 20 A-.
S~}Cff Pi 51",1-0
Notary Public
My Commission expires I~' ~. o!D/' , 20
Signed ~ ,;v--
Commissioner of Deeds
BRUCE PISANO
Notary Public, State of New York
01P14975784 Du!chess County
Commission Expires '~~J..ftr 3.0(.
L BJ-GC-2 (Rev. 3/06)
Page 2 of2
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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
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Date
SCHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST UST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZA nON)
DATE YEARS OF
NAME OF BIRTH MEMBERSHIP STREET ADDRESS CITY
JAII/~Iljt,~EK I 1/ 1 ~-5'1 ~I ;17 I //I;~#, ::f/~-r- IM/Af.~ ~
~Y;~,9dl .3 /~O /~31 dO? Ij;~~' I "" d:.
m__~,~-1 I 1/ / /t- / ~~I il~ I 'f' 'P/.l ~A#5
#1& WP i /P' ~2L~~i ? i"" ~ft"< t~ ~,,L'-C/;.5
1-1-1-1 I 1
1=1=1=1 I I
I 1 1 1 I I
1=1=1=1 1 I
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXlMUM OF 2 AUXILIARIES/AFFILIATES. EACH AUXILIARY/AFFILIATE LISTED MUST HAVE ITS OWN ID NUMBER.)
NAME OF AUXILIARY/AFFILIATE
GAMES OF CHANCE ID NUMBER
11111111111111111111111111111 .J
L BJ-GC-2A (Rev. 3/06)
Page 1 of2
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,- SCHEDULE 7 TYPES OF GArdES -,
List all of the single types of games to be conducted at all license periods enumerated in Schedule 5.
Note forVe!!as Ni!!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 Fhance when less than five single types of games of
chance are to be conducted during anyone license period. I .
LIST NAME OF EACH TYPE OF
GAME OF CHANCE
, (Limit: 5 Games)
UST 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 SHAIL
NOT EXCEED $10,000 AND NO SINGLE
PRIZE SHALL .EXCEED $250
BELL JAR:
INDICATE IF THIS APPLICATION
IS FOR A BELL JAR
UCENSE
YES~ NO 0
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BELL JAR DEAL SHALL NOT
EXCEED I $3,000 AND NO SlNGLE PRIZE
SHA.lL EXCEED $500
RAFFLES:
INDICATE IF THIS APPLICATION
IS FOR A RAFFLE
LICENSE
YESO NO 0
IF YES, UST 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 lliIS CALENDAR YEAR SHALL
NOT EXCEED $100,000. NOSINGLE
PRlZE SHALL EXCEED $50,000
EXCEPT lliAT A SINGLE PRIZE OF
$100,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
"" ~~,...
11111111111111111111111111111
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
November 30, 2009
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, New York 12601
Dear Sheriff Anderson:
Enclosed, please find a copy of "Members in Charge" for Knights of Columbus #1646, 2
East Main Street, Wappingers Falls, New York, who will be selling BELL JAR Tickets
on their premises throughout the year 2010.
I would appreciate your review of the 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,
1 C. asterson
Town Clerk
Town of Wappinger
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
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Date
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
JAII~/ljl,~//t:!( I 1/ / ~-5"'" / --171 ;/7 I /&~// :57aL-r- 1./dI//. ~ ~
~~~.u1 T I ... t> I 5'.51 ilr2 1 ~~};~ , I ~ d;
=~~ W~ 1 1/ 11?-16~1 iil~ 1- ~ . _~.I ~~
/f-fx- ~ I /-9 ~2L~~1 ? i"" VF t:-~ r~.6/~
'-/-/-1 I I
1-/-/-1 I I
1-/-/-1 1 I
1-/-/-1 1 I
SCHEDULE 3: AUXILIARY/AFFILIATE ORGANIZATIONS ASSISTING AT GAMES
(MAXIMUM OF 2 AUXILIARIESI AFFlLlA TES, EACH AUXILIARY/AFFILIA TE LISTED MUST HAVE ITS OWN 10 NUMBER.)
NAME OF AUXILIARY/AFFILIATE
GAMES OF CHANCE ID NUMBER
-111'1'1111'11'111111'1'111'1'11'11'1111 ::1---
-I - BJ-GC-2A (Rev. 3/06)
Page 1 of2
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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
November 30, 2009
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, New York 12601
Dear Sheriff Anderson:
Enclosed, please find a copy of "Members in Charge" for Knights of Columbus #1646, 2
East Main Street, Wappingers Falls, New York, who will be selling BELL JAR Tickets
on their premises throughout the year 2010.
I would appreciate your review of the 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,
I C. asterson
Town Clerk
Town of Wappinger
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
January 4,2010
New York State Racing and Wagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject:
BELL JAR LICENSE - Knights of Columbus #1646 - 2010
Please fmd enclosed the GC-2, GC-2A, GC-2B, GC-4, and GC-5 for the Knights of
Columbus #1646 for the year of2010.
hn C. Masterson
Town Clerk
Town of Wappinger
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
January 4,2010
Knights of Columbus #1646
2 Main Street
Wappingers Falls, New York 12590
Attn: John Gorman
Dear Mr. Gorman:
Please find the attached Bell Jar "License to Conduct Games of
Chance" for the year 2010. I have also attached a receipt for your payment.
Please do not hesitate to contact my office with any further questions
or concerns.
Sincerely,
BELL-JAR-GAMES OF CHANCE
WAPPINGERS COUNCIL K OF C 1646
257
1-108/280
/2- 2..--- G)!L
$ I ;;L S-=-oe
DOLLARS
lJJ;!'~. ...
, )/
2800 .08 .': 0 8 2 7 5 5 ~ 2 2/11 0 2 5 7 '
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