Wappinger ElksTowN cI.ERx
Chris Masterson
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W W W.TO WN OF W APPINGER. US
(845) 297-4158 -Main
(845) 297-577] -Direct
(845) 298-] 478 -Fax
Office of the Town Clerk
January 7, 2011
New York State Racing and Wagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject: Wappinger Elks Lodge 2609
TOWN SUPERVISOR
Christopher J. Colsey
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Joseph P. Paoloni
Please find enclosed the GC-2, GC-2A, GC-2B, GC-4, and GC-5 for the Wappinger
Elks Lodge 2609 for the year of 2011.
n C. Masterson
wn Clerk
Town of Wappinger
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TOWN OF WAPPINGER
enc.
;C-2
YS RACING & WAGERING BOARD
Watervliet Ave. Ext., Suite 2
.lbany, NY 12206-1668
'elephone (518) 453-8460 Fax (518) 453-8492
~ww.racing.state. ny.us
FOR OFFICE 1 1 0 1 $~ f
~TT-T~ `~v
r1SF. ONLY ~e,,.,t~~nHt t .icense Number Fees Received
~~®~ ~
Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MUNICIPALITY
N.Y.S. Idenhficauon Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATI
County
Name of Municipality
PART A. GENERAL
1. Name of Or anization _ C ~ K s L ~ ~ G ~ =~
~,~.) ~~ P i _~ ~ c ~~ ~f 1
2. Address ~ ~ ~~ .~ ~ ~ ~~ ~ W ~~ ! A-~~ N ~ ~ Z ~
3. Has applicant ever been detued a games of chance license? D 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 ~ ~ ~ ~v;~~ Date ~ m
State incorporated ~~--i-~'
Incorporated Association ® m / m / m
Unincorporated Association ^ State incorporated Date
Individual ~
5. Did your corporate status change since your identification ppr~ber was assigned? O Yes ~No
6. Are you doing business under a trade ttatne? ^ Yes ~ No If "yes", what is the trade name?
PART B. LOCATION OF GAMES ~ ~ 3 ~ ~ A ~. ~h L.l-- ~ 1 ~Z~'~~
7. Address where games, bell jar, or raffle drawing(s) are to he conducted. (( (S ~~~- 7~
8. Name and address of authorized games of
chance lessor renting to applicant.
9. Does the applicant own the premises'? (Yes ^ No If "yes", how tong'? ~~
1 U. Capacity for public assembly of premises presently owned or occupied.
.~ I U X12 ~
1 1. Have premises been regulazly used? ~ Yes ~ No If "yes", how long? ~ ~ ive full details.
Are games of chance being played now on these premises or has it ever ~n. Yes ~ No If yes' , g
~L ~
12. Are the premises or any part thereof If "yes", state the type of license and number.
where games of chance are to be played Yes ~ 1`10 ~` L - ~ t~j ~ ~ c-~- ~ ~j
licensed by the State Liquor Authoriry?
13. Has such license ever been ~ Yes ~No
revoked or suspended?
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE ~
BELL JAR ~
RAFFLE ~
_ __~
._ . ri.~ ~~, _ "
If "yes", why? (Explain on a separate sheet, if. necessary, and attach.)
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I
1'AK'1't_'. l'lKl'OSl?ti (-1~' l;:\AiL:S
1=1 ~tatr thr specific Inu~l)use~s lot which thc+ entire uet f,rut:ccala ate to be ~levutcJ tutu in what manner.
I Swr,:at tul .I(Iltluf
1 That ,',L L.:hr :,uuvhe(t 5. u.~lules :ur a nlutr.riul port heleur <uul iuc incurpul ateJ heaeiu i1S iI sCl l/lll I11 lull Ill lI1C 0hI)I ll: ilUUll. Alt IhC 0Il5WG'la
;~xuaiucJ ut ibis uppli~~uiuu itrc a nrucriall pull hereof.
lltat ulc auur net tnuc(aJs vl all gunles of rhanl;e Shull be Jl:\ut1:J c.xlausivei)' to one ur more ul the "lawful purposes" us Jelined in the Gantrs ul
Chance Lrrcnsiag Law unJ the Kules and Kegulutions of the 13uurd.
?. 111'Jl lUl' c'aCh Ill'enar 1.>r11UJ IUI' w'Itl('II it Iti'.L'.nSC li SUllghl, UnC. Ilr IIIUIC UI lI1C alll\'C t11CI11hCr5 1111JC1 WhUSC SIII)CIVIJIUIt lhC ga1lICS afC [U hC llCill,
l~;xratcJ anJ wnJuvlcJ, who is tuuliliur with the Guides of Chuuee. Licensing Low, the Elides anJ Etegulutiuns ut the N.Y.S. Kt-cing b'c Wugerulg
iiuurd nnJ local lictnsinb uuliuaucc~ ul. lows, well he prlxlau al all lintel, III Chal1;C JIIJ pllllli11111' ICal Wllall)iC tUr lt1C CUIIIIIICt UI gallle5.
$. I llal l;)C ll llltl'151gnCJ N'III tll' 1'l'at1UIIS1I11N 1111 the h(11(Illlg, 11111;1011011 ill 111 WIIJ UGI Ut illl ~alllCa UI CIIiU ICI' II1 a(:CUfdt111C'e WIIII lE1C lCtllls UI` II)C IICCII$C,
tho pn:~\taiun, ui ',h~ (_i:4nCS ul Chunx t.iccnsing I.Iw, the Ilulr.s unJ kuguluuuns ui the N,Y.S. tlacutg & \ti aglsring kiuard an(I wttn the prr~lsunu
~)C I1)~,1~ Il~ensnlg utdinan~es ur lows.
Thal the understgnr,l hits real anJ is iuuliliar with the provisions .)C the Ciantls ul Chance Lic(:nsin-; Law ua wncndtd, the kulrs and Ilcgulatiuns
vl Un; "J.l .'> hacins; ~'C \, agatnl; Huard, and the lucid liwoaing ur(lulunccs ur L•nvs.
b, that uu .uuuuJSSiun, aatar), cunlpollsuuun, reword ur reuumpcnse will be paid Ill ally per5U(1 IUr t1UlJlllb UI USSISIJ Its' III IIIC UpCI'OUn~ Or
"ruJuctins ui u1C gooks, e.vl•epl u> buukker.I,els ur alr.nunnulls fur plnlessiuual servil:es in an auluuut out c.\ceediug that tied by the l3vanl.
Uute Jtgn:uurr uC tluad (lf lh'onnicutiun _-~..~-...^T Print Name
O1' N1{W 1't111K
~l .~11~:
~.
(.'CI l'i'I'O4\'N.'`'ll..l-.\l;l : t)t~ _ ~~ S ~t ~ ,~-
being thT,ul_ Y~)rn tlepuse; tutu ay, that (s)he is the; parson about; named,
that ,~.: 1: L:ia rc.lll the furc~l:in~ ,u1~~unJ thu answer llterein Holed, and thin such answurs :u l; trur. lit d that (s)he has personally.
;illl.v..l; hla ~Ilcr~ slgr,aturu ;lr Utis :tllidnvU. ~ /i ~ I
:;w,un to >rt.!rc uIC Ihls I 'TJ~ flay' l~l 11 G~~, ~(1 ~~ Signe.tl
~ut:o v I'uhlic
;1'Iv Cutnntisulnt cxpilrs _. ~ ~!~_ ._' _..__, ~ ~`O ~-
issiuncr
HERMAN VELEZ
Notary Pudic -State of New York
ID No. 01VE6101982
Qualified in Dutchess County
fay Commission Expires November 24, 2011
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APPLICATION FOR GAMES OF CHANCE LICI;1`SE _,S,
NY5 RACING & WAGERING BOARD
1 Watervliet Ave. Ext., Suite 2 ,; ..
Albany, NY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-849 ~ T"
www.racing.state.ny.us
WAPP I NGE R EL KS L ODGE 26 09
Name o~Organization
- - 1 9- 6 0 2 - 0 2 0 1 3 ~/~/~
GC 1 3 ~ ~~
NYS Identification Number Date
SCHEDULE 1. OFFICERS AND DIRECTOP.S
.ist names, addresses and dates. of birth of all ofi-cers.
f organisation is a corporation, or an inch oA t~ed~Eor unincorporated association, list officors and directors.
DATE OF BIRTH STREET ADDRESS CITY
~ ,~ / /
L NGk7I .,~L ~Ft~t?n I f~ /~ ti, ~ - I~3yA•JJn.~s I I
J .,i4I~.tR ~"~~~-~ ~ `~ ~ ~ ~ .`~~--?i~~n ~ ~(~~~,,.'t/ 3cl I ~L53 ~
~~~ ;,~ ~~~~~ >~,'.vc - ~ I~/~z-/~r/~~Is~ ~c~~~i~,.,- ~d Iw't~~ ~/!s I l z s~~~
n
' { _~ a / ~ ~ ~+r/ I v~.,,~ ~ -rte /I S I / 2 s `r
~~ iy~u~i~~ I - ~,~ ~-~' c ~ / 2 S / ~ Lzl ~ ~ - 2 a-'
I
S ~~ , ~ i ~ a,4~ ~~ ~ ~'l o ~ /1yz. Its°~', ~ ~` -~ --
~"~~~AS ~' ~- I l ~4vit ,! t.4 ~ ~ u-(i S ~f -IL--' ~'. ~.~ ( //~ -S7~ 15~~fiu!//~'r(~'_ I ~, , /~S I l ~ -~ `l ~
Attach additional sheet if necessary.
SCHEDULE 2: MEMBERS IN CHARGE OF GAMES
(MUST LIST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YF,ARS OF ZIP
NAME ~ OF BIRT~i MEMBERSHIP STREET ADDRESS I CITY I
I / / I - I LaGrange 12540
I~ (
au Bader I 9/ 20 / 1965 I 14 I 134 Anderews Rd
Simon Kaufman I 8/ 16 / 1930 I 7 1 9 S View t" I Hopewell Jd I 12533
I 7 / '~ / ~ I I W~nninnorc G711c I~~+~~
Lewis Hakim _i,-- ~-I I I
I ~R 1 ~ 911.+ .. Ol.~ro
Greg Samo 7 / 01 / 19361
1 / / I I I 1
/ / I I I I
I / / I I I
i ~ / I I
S CHEDULEfi3~-- ~ Ul•1 0FI AUXR.IARIES/A1rFQ.dAT1T EO~G x~v,~A~~tA~ LAI3TBD MUSTvH E TfS O NMENUMBE[:J
NAME OF AUXILIARY/AFFILLATE GAMES OF CHANCE ID NUMBER
BJ-GC-2A (Rev. 4/03)
Pape 1 of 2
W~III~mVfiIIIIINIY J
SCHEDULE 4: ASSISTANTS TO MEMBERS IN CHARGE OF GAMES
List all members ofapplicant organization afn~d mher of aPPI•canoorftanization o affilia cifo atvleaswill ~ist with garncs•
YEARS OF
DRES S
ZIP
MEMBER NAME DATE OF B~ TH MEMBERS i IP STREET AD
1 s,s~ ~ nn~NCd ~~ /
/ / ~
I / /
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/ /
/ /
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/ /
/ /
/ ~
I / l
I / /
/ y /
I / /
( / /
I / /
I / + /
I / 1 /
I / /
( / /
I / /
/ /
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/ /
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/
I /
I /
I l /
Y l
I
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I
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Attach additional sheet if necessary
L BJ-GC-2A (Rcv. 4/03) Page 2 of 2
':=~t.
;;
Each person listed must be o
CITY
~In011111VB~I11B J
Schedule 4. Assistants to Members in Charge of Games
First MI Last Name Address
Frank Abato 39 Kensington Drive
Philip A. Abbate 6 Hackensack Hghts Rd
Robert Acquanita 10 Vorndran Drive
Ralph J. Anzivina 12 Thorns Lane
Henry J. Boldrin 28 Gold Road
Harold A. Crawford Sr. 318 Sunset Hill East
Francis J. DeGano 27 Brandy Lane
Roger DeJordy 83 Kent Road
Robert Fischetti 91 Ardmore Drive
Mark H. Fox 28 Tiger Road
Harris C. ~ '-Jones 217 Brothers Road
Robert J. Juliano 2776 West Main Street
William K. Minkowski 427 McGrath Blvd.
Rosemarie Perretta 35 Cathy Road
Gregory F. Sarno 13 Dana Place
Kenneth J. Tucker 34 Pawling Lake
Robert N. Wallner 7 Kinry Road
Years
Town Elk DOB
Hopewell Jct 11 04/24/1940
Wappingers Falls 18 05/16/1937
Wappingers Falls 22 05/25/1942
Highland 22 12/21/1935
Wappinger Falls 15 01/11/1936 _
Fishkill 18 02/23/1936
Wappingers Falls 18 0711.811946
Wappingers, Falls 18 09/19/1944
Wappingers Falls 28 06/07/7926
Hopewell Jct. 14 09/15/1957
Stormville ~ 18 04/2411944 -- -
Wappingers Falls 13 10/05/1953
Fishkill 28 03/20/1942
Poughkeepsie 8 09/07/1943
Wappingers Falls 28 07/01/1936, _ .
Pawling 9
Poughkeepsie 19 01/17/1933 -
GENT ON FILE l~
NO ARREST BY THIS A
W-Tt11NFORMATI~'i F
A
,,.
iD BUREAU
~1~1[Y SHERIFFS OFFICE
Dl)1>~~S
NORTH HAMIL'TC~`i S1R~F
150
OUGHK~~IE'~
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P
/ 20 ....
I
G C-2B
NY'S I2A('ING &•- WA(~Et21N(; t;()At2D
I \Vutervliet Ave. Ext., Suite 2
r\lbany, Nl' 1?2lXy-1668
1'rlephunr I,J l8) 453-84hU lux (518) 45.)-:5492
www.r:~~iug.state.ny.us
APPLICATION FUR GAMES OF
CHANCE LICENSE
T
,~
a ~
I~~{ ~P ~ i L~C R ~~LK~ L.o'~ G ~ ,~ LyY
Nunez ut Organit.ation
GC- ~ - . ~ ~ - C1 v ~- - J D ~ L!J (uld~ I ~ D '~
NYS tdentitication Number Dace
SCIiEllULE 5 llA'TES, HOURS AND RENT OF ALL LICENSE PERIODS `TO BE H)H:Lll
1 ~'~rOT APPLICABLE FOR BELL JAR GAMES)
DATE ~ HOURS RENT
y.~ / _ ~7 ~{ / ~L y~ ~ F~~am p~mJ ~ ; ~u~ prn ~
d ~ l ~ ~~ . l ~ >~ ``~~' ; ~~. ~ am rr - _ 1 Z . - an / pn>
,__U_.~_ / CU ~ / ~ / ~~ ' ~ ~ am pr1 - 1 ~ ~ . ; ~~ ~ am / pm ~
~~ / ~~ ~ / /~ - ~ :, t~.~ am prn - /.•L.: ~~ a pm ~~
~_.. __.- / ~-_ / ..-.~._ ~_~.._. ~ ~ am /prn - am / pn1 ~ ~ .
/ / ~ am /prn - am / p(u ';
~•
/ / ~' arrr /prn - ant /pnr '
._. ~. ,_
/ / ~ am / pm ~ am 1 pm ~
_.~ / i / ~ i . ~ ~am / pm -~ ` ain / pill ~ ~ .
ftA I~ FI.I+ ti
DA'I'S TIME PRIZES (Cash or Fair Mur-l:ct
Value of Merchan(iise)
.~._. _~ / - / • rut) / pm -
! am / pm ~
/ / . ~
~ `_ um /prn -
. . am /prn
/ / ` ainlpm -
~ •
~_ .•~ am/pm !~
/
am / pm
~
._•~~ • J
am / pn)
~~
~
SCHEUE-LE 6 I;XI'ENSES
List items of expense t() be incurred, and t11e nanles aild addresses Qf pers ons ca he paid.
1'i'k:M Ul~~ E?i1'Ir NSE VENDOk NA
ME STREET ADDR ESS CITY S"t'ATE L1P
! CJ u' ~',C~ ,
,;
39
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Ptrge i of '?
~umnuu~wi~ ~
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 Vegas Nights and Bazaars only: The total amount of prizes during any one 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 any one license period. The total amount of prizes during any one 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 any one license period.
LIST NAME OF EACH TYPE OF
GAME OF CHANCE
(Limit: 5 Games)
L ~~
~E""
l
LIST THE Iv~LAXIMUM AMOUNT OF PRIZES
TO BE AWARDED FOR EACH TYPE OF
GAME OF CHANCE (GAME BANK)
at $ ~~~ ' a~)
at $
at $
For Merchandise Wheels, Bell Jazs and Raffles, please complete the appropriate spaces below.
MERCHANDISE WHEELS:
THE TOTAL AMOUNT OF PRIZES FOR
INDICATE NUMBER OF EACH MERCHANDISE WHEEL SHALL
MERCHANDISE WHEELS NOT EXCEED $10,000 AND NO SINGLE
(NO LIlVIIT) PRIZE SHALL EXCEED $250
BELL JAR:
INDICATE IF THIS APPLICATION
IS FOR A BELL JAR
LICENSE
YES ^ NO ~
RAFFLES:
INDICATE IF THIS APPLICATION
IS FOR A RAFFLE
LICENSE
YES ^ NO t~
IF YES, LIST RAFFLE DATES, TIME(S)
OF DRAWING(S) AND PRIZES IN
SCHEDULE 5
THE TOTAL AMOUNT OF PAYOUTS
FOR EACH BELL JAR DEAL SHALL NOT
EXCEED $3,000 AND NO SINGLE PRIZE
SHALL EXCEED $500
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
1
GC-4 FINDINGS AND
NYS RACING & WAGERING BOARD DETERMINATION _ ~ '~,
1 Watervliet Ave. Ext., suite 2 FOR GAMES OF CHANCE
Albany, NY 12206-1668 ~
Telephone (S18) 453-8460 Fax (518) 453-8492 LICENSE ~ ~-
www.racing.state.ny.us
GC-m- ~ - 6 0 2 - >_ >. o
N.Y.S. Identification Number Municipal License Number
After investigation, and a hearing if required under Sec. 1
have been made:
1. All the members-in-charge designated in th ap~~~~.~i
character and have never been convicted a c ((rr ~~//,
Signature of Person Conducting Investigatic
Municipal Law, the following findings and determinations
of chance are of good moral ~ Yes ^ No
Title ~ -' K=-f t
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 of the N.Y.S. Racing and Wagering Boazd, 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)
g] Yes ^ No
~1 Yes ^ No
® Yes ^ No
® Yes ^ No
~] Yes ^ No
® Yes ^ No
$] Yes ^ No
® Yes ^ No
^ Yes ^ No
TO BE COMPLETED BY MUNICIPAL CLERK:
As a result of the findings and determinations stated above, license is GRANTED :license is DENIED ^
Signature of
Filing date of Application December 22 . 2010 Authorized Officer
(Municipal Licensing Authority)
Date l~'~ I ~ i Title Town Clerk
ONE COPY OF THIS FORM TOGETHER WTTH 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. I
L BJ-G G4 (Rev. 4/03) III it VIII I II III IIII II I II IIII J
1195 Rte 376 WavningQra Fal l c~NY 1 ~59f1
Address
TOWN CLERK
Chris Masterson
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
WWW.TOWNOFWAPPINGER.US
(R45) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-1478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
December 22, 2010
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, NY 12601
Dear Sheriff Anderson:
TOWN SUPERVISOR
Christopher J. Colley
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Joseph P. Paoloni
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 February 4, 2011, March 4, 201 1, April 1, 2011, May 6, 2011 and June 3, 201 1.
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,
,~~~
ohn C. Masterson
Town Clerk
JCM/cf
Enc.
Susan G. Havelka
Joseph P. Havelka 20rJ/~,
38 Hickory Ln /~
Pawling, NY 12564 V 20~Q so-essi2ie
845-855-3731.
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Pewling,NewYork12584
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