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Wappinger Elks (2)1 GC-5 NYS RACING Xc WAG)/RING 13GAItD 1 IIroadway Center, Suite 60U Schenectady, NY 12305-2553 Telephone (Sl8) 395-5400 Fax (518) 347-1469 www.racing.state.ny.us LICENSE TO CONDUCT GAMES OF CHANCE PLEASE CHECK GAMES OF CHANCE ^ BELL JAR ~1 RAFFLE ^ GC-m-? 1 ~-~~- N.Y.S. Identification Number ~w , a ~ ~ ~ Y~*p~yyrw,-+ ~.. ~~• • This License Must Be Conspicuously Displayed During Conduct of Games Address: 1195 Route 376 ~ ~ Ctty: Wavvingers Falls Zip Code: 12590 Entire net proceeds to be devoted to the following specific lawful purpose(s): Charity. Patriotic Effnrrc_ Yn„th and F.rl„ratinn~l Names of Members in Cltarge Alex P. Czarniecki Paul Bader Greg Sarno Simon Kaufman LICENSE PERIOD DATE DAY OF WEEK HOURS TYPE(S) OF GAMES 2011 RAFFLE DRAWING DATE DRAWING TIME DRAWING LOCATION AMOUNT OF RAFFLE PRIZES (Cash or Merchandise Prizes at Fair Market Value) THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED FOR EACH TYPE OF GAME OF CHANCE FOR EACH MERCHANDISE WHEEL $ $ NUMBER OF GAMES EACH GAME (Starting Bank) NUMBER OF WHEELS EACH WHEEL THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR GAMES SHALL BE PLAYED IN ACCORDANCE WITH ~ DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE STATE LAWS AND RULES AND LOCAL ORDINANCES OR SHALL EXCEED $500. LAWS. Issued by Town of WaFFin~er (Name ofMunicipality) September 15, 2011 (Date) BJ-GC-S (Rer. 3/06) John C. Master on (Tit] of Authorized Officer) (Signature of Aut orized Officer) III III) III I~~IIIII II II III I III ul 4 I 1 1 0 4 $ ~- Municipal License Number Amount of Fee Paid Lessor's License Number 1 GC-4 FINDINGS AND v NYS RACING & WAGERING BOARD DETERMINATION 1 Watervliet Ave. Ext., Suite 2 - Albany, NY 12206-]668 FOR GAMES OF CHANCE ~ Telephone (518) 453-8460 Fax (518) 453-8492 LICENSE www.racing.state.ny.us CiC - 1 3 - 2 1 9 0 2 ~~ 1 '~ 1 1 0 4 N.Y.S. Identification Number Municipal License Number Name of Municipality ame of Applicant Organization ___.1195 RA71tP 37fi~ Wa~,~tingarc Fallc~ NV 125Q0 Address After investigation, and a hearing if required under Sec. 192 of the have been made: 1. All the members-in-charge designated in the app ' character and have never been convicted of a i Signature of Person Conducting Investigation Municipal Law, the following findings and determinations res of chance are of good moral [a Yes O No Uy~ Title '~ ht:~ t TT -r~-~-- 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) ~7 Yes ^ No ~Cl Yes ^ No g{ Yes ^ No ~1 Yes ^ No ~l Yes ^ No ~7 Yes O No $l Yes ^ No ~7 Yes ^ No O 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 n/} ~ ~ Filing date of Application September 7 , 2011 Authorized Officer ~~ (Municipal icensing Authority) Date C1 S~ Title Town CLerk ONE CO Y 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. ~v4~,~ ~„ mwAidiwnoiii~ J TOWN CLERK Chris Masterson 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 W W W.TO WNOFWAPPINGER.US (845) 297-4158 -Main (845) 297-5771 -Direct (845) 298-]478 -Fax TOWN OF WAPPINGER Office of the Town Clerk September 15, 2011 New York State Racing and Wagering Board 1 Broadway Center, Suite 600 Schenectady, New York 12305-2553 Subject: Wappinger Elks Lodge 2609 SUPERVISOR Barbara A. Gutzler 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. . J n C. asterson wn Clerk Town of Wappinger JCM/cf enc. TOWN CLERK Chris Masterson 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 W W W.TO WNOF WAPPINGER.US (845) 297-4158 -Main (845) 297-5771 -Direct (845) 298-1478 -Fax TOWN OF WAPPINGER Office of the Town Clerk September 15, 2011 Wappingers Elks #2609 1195 Route 376 Wappingers Falls, NY 12590 Dear Mr. Czarniecki~ SUPERVISOR Barbara A. Gutzler TOWN BOARD William H. Beale Vincent Bettina Ismay Czarniecki Joseph P. Paoloni Please find the attached Bell Jar "License to Conduct Games of Chance" for the year 2011. I have also attached a receipt for your payment. Please do not hesitate to contact my office with any further questions or concerns. Sincerely, n C. Masterson 'wn Clerk JCM/cf TOWN CLERK CI-ris Masterson 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 W W W.TOWNOFWAPPINGER.US (845) 297-4158 -Main (845) 297-5771 -Direct (845) 298-]478 -Fax TOWN OF WAPPINGER Office of the Town Clerk September 6, 2011 Adrian Anderson, Sheriff 150 North Hamilton Street Poughkeepsie, N Y 12601 Dear Sheriff Anderson: SUPERVISOR Barbara A. Gutzler TOWN BOARD William H. Beale Vincent Bettina lsmay Czarniecki Joseph P. Paoloni Enclosed, please fmd a copy of the "members in charge" of the Wappinger Elks #2609, Route 376, Town of Wappinger, who will be selling BELL JAR Tickets on their premises throughout the year 2011. 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. Yours truly, ~~~ n C. Masterson own Clerk Town of Wappinger JCM/cf 1 GC-4 FINDINGS AND u NYS RACING & WAGERING BOARD DETERMINATION l Watervliet Ave. Ext., Suite 2 Albany, NY ] 2206- ] 668 FOR GAMES OF CHANCE Telephone (Sl8) 453-8460 Fax (518) 453-8492 LICENSE www.racingstate.ny.us CiC- 1 3 - 2 1 9 0 2 1 1 0 4 N.Y.S. Identification Number Municipal License Number Town of Wavpinger ~ DutchecG Name of Municipality Count W A D D i n Q e r F. 1 lr ~ ~ ~ Name of Applicant Organization After investigation, and a heating if required under Sec. 192 of the General Municipal Law, the following findings and determinations have been made: 1195 R()11YP ~7Fi,~ Wad= ingcrc Fal l c~ NV 12SQ~ Address 1. All the members-in-charge designated in the application to conduct games of chance are of good moral p Yes p No character and have never been convicted of a crime. Signature of Person Conducting Investigation Title 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 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. ICl Yes ^ No ICl Yes ^ No $1 Yes ^ No ~] Yes ^ No ~1 Yes ^ No ~] Yes ^ No 8. There is satisfactory proof that the type and value of prizes offered and given will be in accordance with the ~1 Yes ^ No 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. ~] Yes ^ No 10. Other findings: (Specify) O Yes O 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 September 7 , 2011 Authorized Officer (Municipal Licensing Authority) Date 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 WAGERIIVG BOARD FIVE DAYS PRIOR TO THE FIRST AUTHORIZEI~D LIlCENf S IE` PERIOD. L BJ-GC-4 (Rev. 4/03) III II IIIIi ~ 1~ Ili Illl ~~ ~"I~I -GC-2 NYS RACING & WAGERING BOARD ] Watervliet Ave. Ext., Suite 2 Aibany, NY 12206-]668 Telephone (518) 453-8460 Fax (518) 453-8492 www.racing.state.ny.us APPLICATION FOR: PLEASE CAECB GAMES OF CHANCE D BELL JAR RAFFLE FOR OFFICE ~ J ~ 1 y I ~ $ ~ r ®~ USE ONLY Municipal License Number Pees Received .Date INSTRUCTION5: PLEASE FILE THREE SIGNED COPIES WTI'A MUMCIPALITY Gc - /[~] - 2 1 - 6 0 2- 0 2 0~~ N.Y.S. Identification Number IT IS A MISDEMEANOR TO MAKL ANY FALSE STATEMMENT~ IN THIS APPLICATION ~owN of w~na~Ng~'2 ______ _ J7yfic~ Ess Name of Municipality County . PART A. GENERAL 1. Name of Or a~ization ~wf+,~T/~ I rJ I N G ~ i. Address /2 o v f 'r 3 6 Gt/A ~ ~ ~i ~ys 3. Has applicant ever been denied a games of chance license? D Yes ~ 21610 2 No If "yes", why? (Attach extra sheet if necessary) 4. Check type of organization and, if 8pplicable, give -the :Stateand -date of incorpaaation. . Corporation ^ r / (,~ in orated Association State incorporated NEW l d 2 ~ Date ~ ~ ~ ~ © . ccap Unincorporated Association ^ State incorporated ` Date m / m Individual ^ 5. Did yoor corporate status change since yourideatification mtmberwas assigned? D Yes ~No 6. Are you doing business under a trade Warne? ^ Yes ~No If "yes", whit is the trade name? PART'B. LOCATION OF GAMES / ,, (~ 7. Address where games, bell jar, or raffle drawing(s) are to be conducted. ~~ q S 1 ~o u ~ . 3 ~6 ~~ i,~ ~,~ / V y 8. Narne and address of authorized games of chance lessor renting to applicant. N/~ 9. Does the applicant own the premises? Yes ^ No If "yes°, how long? 2 ~ y E,4,Q f 10. Capacity for public assembly of premises presently owned or .occupied. _ ~~ Q 11. Have premises been regularly used? Yes D No If "yes", how long? 2 ~ EAR 1 Are E~ .of chance being played now on #hese premises or bas it ever been?Yes .D No 'yes", give full details. A2 Ta 12. Are the premises or any part thereof If "yes", state the type /of license and number. G / p~ where games of chance are to be played Yes D No C`f'v ~ ~ J ~ L.1 C ~ f/s E ~ G 7 0 6 2 3 O licensed by the Stateliquor Authority? 13. Has such license ever been D Yes ~No ~ "yes", why? (Explain on a separate sheet, if necessary, and attach.) revoked or suspended? --i PART G PURPOSES OF GAMES 14. State the purposDes for which the en/ti-re/n~et ~ ar~e/to be voted and in what/manner. C~A2-I"~f ! A~/~.10~1C C'y"T17~K1J lnV l~ ~NC~ ~cIuCA~10~•~ I away (or af5rm). . 1. That ALL the attached Schedules are a material part bemof ead are incorporated herein as if ad out in full in the application. All the answere contained in this applieadon are a material pert heroof. 2. That the eatiee net procxeds of all genus of charux shall be devoted exclusively to one or more of the "lawful pnrPoaes" as dei3ned in the Ceases of {~adoe Licxruing Law and the Rulaa and Regulations of tlu Board. ~ . 3. That for each Uexnae period for which a licerree is sought, one oc more of the active numbers under whose supervision the games are to be held, operated and wed, who ie familiar with tbo C3ame8 of C,hence Lic•.earsing Law, ~R manly responsible for the onduct of ~ wig Board and local lic;enaiug ordinances or laws, will be prraertt at.all limos, in charge pri .{, That the midersigned will be responsible for the holding, operation end conduct of all games of chancx in :accordance with the terms of the license, the provisions of the C3aarrras of Chance Licxrising Law, the Ruies and Regulations of the H.Y.S. Rating & Wagering Board and with the provisioas of local lia~eing ordinances or laws. S. That the undersigned has read and is familiar with the provisions of the t3anus of Chancx Lic:arsing Law as amended, the Rules end Regulations of the N.Y.S. Racing & Waring Board. aril the local licxndng ordinance or laws. 6. That no commission, salary, compensation, reward or recompense will be Paid to any person for holding ar assisting in the operating or conducting of the games, except m boolclceepem or accountants for' Professional service in ea amount not exceeding that fixed by the Board. Dare 'Signature of ization Tiz~r~FR~ti~~~~r~J STATE OP NEW YO COUNTY oP ~ v ~ ~ ~ F S S SS ~ffOWNN~.L'ACiE OP / N ~ 2 / • C_'zARN~/s'c~/ IFx Print Name F / , 2 / C being duly sworn deposes and says that (s)he is the person above named, that (s he has read the forego statement and the answer therein noted, and that such answers are true and that (s)he has personally affixed his (het') signature to this affidavit. =_ day of S~, 201( _ .Signed '~' , Sworn to before me this ~a r b a,~. I~ • G, ~-f z ~ er- aioner ~af Reeds • i+lotary iPitbl>c My Commission expires ,(`'Ga f~ ~- g , ~ ~- BARBARA A. GUTZLER NOTARY PNOL101 GU6020894 EW YORK QUALIFIED IN DUTCHESS COUNTY GOMMISSION EXPIRES ~f S/ rs , . GC 2A APPLICATION FOR GAMES OF CHANCE LICENSE NYS RAQNG & WAGERING BOARD 1 Watervliet Ave. Ext., Suite 2 Albany. NY 12206-1668 Telephone (518) 453-8460 Fax (518) 453-8492 IwiA I~ IP I ~ I~ IG 1 ~i ~I i c~ ~-l~rls ~ z ~ 0 Name of Organization GC- f 3- 21 - 602 02D i3 NYS Identification Number •,d • .r.:. _111 _;`~; mimim SCHEDULE 1: OFFICERS AND DIRECTORS l,c aamea, addeeWea and da0et of birth otaU otAoe~s. F arSaaizuioa ie a cw~pocuion, ~ an iacazpoated a nniacosPoraped aaociadm, Wt otBoan aad dieeotoa. N DA OFB TH STREET.ADDRESS Fx~ F v F,/~ k D1 lv >~ a l a ~ 0 3~~I i~ oR~ff wa ~EA~iu !vt ~ I CTThR 0 LGA `I -.~.l~l ~S •I /7 Pa7a6,t1 7RAc~ ~d Lo A N I J I YJ o (_Q~./ 27 /~ I v~ T~AAat6 s I ? ~R ~h. ~ ~ A I os/ Zs ~ y2 I /o ~a'R~~ a~~ ~ ~~~ 7R~1R.ivR~Ef/t •~ M" A ~vI J Q I OZ- / D~/L/ SO (S~ >'7i/I~J T~RRAc~ T vsTF&1 ~-hAtaMA~ E IP C2i-RN~b ~ ( ( l ~ / 1._./~ I -3 ~ ,,~~--E 6~v ~R ivy' 7'av.tfE~ I Rocto EN I 66/ 0~ /~I 6 riS ill ~.~ I TR ~ 1 f ~ ~ I .n I /~a .t J' I~_ / 2 & / 3 ~ I l3 L 11 ~ I ~avStcE I ~~M~~ Go! ~TI~/ Zs-/6~ I zs~ ~ ~ ~~ s,~~i 7 ~l ~ ~ I _~rl Ax ~A o Imo? l~1/..~.I 2 Uwy~~c LAND I -~ Attach :additional shoat if necessata~. ~V~I ~ 2 da 3 2 6D3 ~~ ~ Zs~o Nyl i- UiP ' ,n+ ,s~/ f AI6 N'1 ~~D I k / VNC /r ly ~j 3 c E~~ ~ N.JI,. z s d ~.f'e ~A.r A~4 fYE/ / Z cl ~6 9 SCHEDULE 2: ME1I~ERS IN CHARGE OF GAIVII~'S (MUST LIST AT LBAST FOUR MBMBBRS OF APPLICANT ORCiANiZAT101~ DATE ~ YEARS OF OF BIRTH MEll~ HIF S ADDRESS CITY ZIP AME ~ ~ J , I / 'Ec ~2A,FN~~cr~I ~4 ~_.1=./ ~' I-~I 3~ tl~ 6N ~RIVS li(/a i ~',~~ ~G /V l2f ~D i v A I ~ ./ /2~0 / ?~~ I ?~ I N /L ~1 I L RA v1 / z GR¢ ~ RNU I G7 /=..!_,s~` I_,L~I l~ cS I ~ /° ~~~ IZS O f11~.,~ a,~A-av I~~-/~/~.~I >d I .~ rs,, awc I I /ZS3.~ I / / I I I I_ I i l l I i I / I I I I • I ~/ ~ 1 ,I ~ I I- I // I i I I SCHEDULE 3: AUIIILIARY/AFFILIATE ORGt~1~TIZ~i1',IONS .ASSISTING ~T GAMF.,S t (MAXIlvIUM OF 2 AU7CII,IAR>BS/APFII.IATSS. EACH AUXII.IARY/APPII.fATB LLSTBD MUST HAVE 1TS OWi~T ID MlMBBR.) NAME OF AUXII.IARY/AFFILIATE BJ-G42A (Rev.4N3) GAMES OF CHANCE ID NC7M~ER Page Y oft I~IBIVI~IBB J ERS IN CgARGE OF GAMF•S ,~ $~DiJLE 4: ASSISTANTS TO MEMB aho „~rUt,usisc.vlm ~. >~ !~°°° u~ mac >~ e , oa sad mmabe:a ~ auto aflillstes and auxiliary ].iat all mantbers cf applipat ot~d ~~ of aDDL'cent orRaaization or atffuau for st last I year. YEARS OF ~~ ZIP MEMBER NAME 'DATE OF BIRTH MEMBERSHIP STET ADDRESS I 1 1 / =/ I I - - i - I ! I ___- I i t ~~"~~ I I i i____I ____l - i I I / I-1 I I I- ____- i ----- I I i I / -/ - I I____ - i I I ______ I_I_-/- i - I I i l/ I I I I_. _..._- i i I~. i / I -- I i _____ I I i i I ____ --- i I I I _I _____ - -/ I --- -- i I I /-- / - I - i .-.. __--. -- I I- I i I ______ I -I -I i ---- I I _______ I _1 _._. I .- I i I.- I i I i ! /-I- I i -I-I- I - I ______ _.-- - / I ~ I I I ____ I____~.-. - I I I /-./- I- I I I I l / I - I ~I - _._-1 i I 1 I-I - _._- -- I I - 1 / I I-I I - /- / ~ i ._._. I I I - - i I 1- I -/-/._.- I .._.. I ~I I/ I I ____ I I I:_/ .- -/ I I i I I _.._ .___.._. I I ./ I____ I ..~ I _____ -I I i I ~ I I - ~I I I I _____ / _-- / I ___._ I I I I---- - - I I I I - `____ _--- / I ~ - .Attach additional sheet if necessary. Page 2 of 2 ~I~I~YIYIIN GC-2B VYS RAQNG & WAGERING BOARD l Watervliet Ave. F.xt., Suite 2 4lbsny, NY 12206-1668 tdephora; (518) 453-8460 Faz (518) 453-8492 +vww.racing.rtate.ny.us Name of JJNIGI~IR APPLICATION FOR GAMES OF CHANCE LICENSE ~ K s ~121GIQ GC- / ~ - ;-~~`j - ~ D 2 - 0 Z 0 / NYS Identtficatton Nnmiu•r ~f~ S':i: ~ ~, ~~~~~~ .;' ~~r ~,~ ~ ,- _ ~; ~'~1 - .o-.:. ti ...~! mimim SCHEDULE 5 DATES HOURS AND RENT OF ALL .(NO LICEN T APPLICABLE FOR BELL JAR GAMEST SE PERIODS TO BE HELD DATE . HOURS - RENT .,. / / - ( .:. am /Pm ... am / pm i • .~ / •~ .. ~ / -r / ~ I • am /pm .: -•- ..` ~ am /p ~ ~ m . ... ' . / . / .- . ~ - am /Pm ; ~ - .,. ..~ am /p I ~ m , ~ ./. ./ I _ _ . ..~'_ / . / ~ I - ~ ... am /pm .: •~ am /pm I ~ • .. ~~ I .. ~ ..L L .. RAFFLES DATE T~ .PRIZES (Cash or Fair Market ' I Value of Merchandise) • ~ ~ - I • •am /pm - ~ ~ am /pm 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 TTY :STATE ZZ~ ' - M~ ~~~= Bli10111~11 J (''' ES OF GAMES w I SCHEDULE ~ TYP List ~ ~ the single types of games to be conducted at all license periods enumerated in Schedule 5. as Ni hts and Ba ars onl :The total amount of prizes during nay one license period shall not Neste for Veg s ~ ~ aggmg~ more than $400 for each single type of game of chance when five types of games of chance are to e conducted during any one license period. The total amount of prizes during any one license period shall not IDore than $500 for tech single type of games of chance when less than five single types of games of ~~~ an one license period. chance are to be conducted during y LIST NAME OF EACH TYPE OF GAME OF CHANCE x ~ (Limit: .5 Games) LIST THE MA~~NiUM AMOUNT OF PRi7.ES TO BE AWA~3~ FOR EACH TYPE OF GAME OF CHANCE r~,~ME BANK) at $ at $ at ~ ~ $ at $ . For Merchandise Wheels, Bell Jars and Raffles, please complete the appropriate spaces below. MERCHANDISE VV~ THE TOTAL AMOUNT OF PRIZES FOR INDICATE N[7IViBEIt OF EACH MERCHANDISE WHEEI' SHALL MERGIiA1~DISE y~~~,S NOT EXCEED $10,000 AND NO SINGLE (NO LIlvD.1~ PRI7.E SHALL~EXXCEED $250 BELS. 7AR: THE TOTAL AMOUNT OF PAYOUTS IlvI3ICAT'E ~ THIS APPLICATION FOR EACH BELL. JAR DEAL SHALL NOT IS FOR A BELT. JAR EXCEED $3,000 AND NO SINGLE PRIZE LICENSE. SHALL EXCEED $500 YES ~ NO D IlJDICAI'E ,~ THIS APPLICATION IS FOR A R.AFFI.E LICENSE YES ^ NO I,s( IF YES, LIST RAFFLE DATES,'I'IlVIE(S) OF DRAWING(S) AND PRIZES IN SCHEDULE ~ TIC TOTAL AMOUNT OF PRIZES FOR ALL THE TZ:AFFLES 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 1F SO INDICATED IN SCHEDULE 5 P.~, , IDI~~IB011~E1