Knights of ColumbusTOWN CLERK
Christine Fulton
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
January 4, 2012
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 - 2012
SUPERVISOR
Barbara A. Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Michael huzmicz
Please find enclosed the GC-2, GC-2A, GC-2B, GC-4, and GC-5 for the Knights of
Columbus #1646 for the year of 2012.
Christine Fulton
Town Clerk
Town of Wappinger
1
GC-5
NYS PACING & WAGI/RING BOARD
1 Broadway Center. Suite 600
Schenectady, NY 123U~-253
Telephone (518) 395-i4(]U Fax (518) 347-1469
www.racingstate.ny.us
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE O
BELL JAR ~7
RAFFLE ^
GC-m- 2 1 9- 6 0 1- 0 2 1 2 0
N.Y.S. Identification Number
1 2 0 1 $ 25.00
Municipal License Number Amount of Fee Paid Lessor's License Number
The following organization:
f C o l u m b u s
Address: City: Wa in ers Falls Zip Code: 12590
2660 East Main Street PP g
Entire net proceeds to be devoted to the following specific lawful purpose(s):
Names of Members in Charge
James O'Connor
John Gorman
Thomas Lynch III
John Simon
LICENSE PERIOD
DATE DAY OF WEEK HOURS
2012
RAFFLE DRAWING
DATE
>.
~d ~'3 ,a~
...-t„ ,
t
'~ ~~~~
,~
This License Must Be
Conspicuously Displayed
During Conduct of Games
TYPE(S) OF GAMES
DRAWING TIME DRAWING LOCATION 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 (Starting Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $3,000 AND NO SINGLE PRIZE
',SHALL EXCEED $500.
Issued by Town of WappinQer
(Name of Municipality}
~,.. ~~ C~oi a
~ (Date)
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.
Christine Fulton Town Clerk
(Title of Authorized Officer)
(Signature o Authorized Offtcerl
IIII III (II (I~~I (I II III ~ III III
1
GC-4 FINDINGS AND ''
NYS RACING & WAGERING BOARD DETERMINATION .. .
l Waterv]iet Ave. Ext., suite 2 FOR GAMES OF CHANCE
Albany, NY 12206-7668 ~
Telephone (518) 453-8460 Fax (518) 453-8492 LICENSE
www.racingstate.ny.us
GC-m- 2 1 - 6 0 1- .
N.Y.S. Identification Number Municipal License Number
Town of Wappinger
Name of Municipality _
LKInIiI;; Ih It Is
Name of Applicant Organization
Dutchess
-~
2260 East Main Street, Wappingers Falls, NY 12590
Address
After investigation, and a hearing if required under Sec. 192 of the Genera] Municipal Law, the following findings and determinations
have been made:
1. All the members-in-charge designated in the ap nd game of chance are of good moral Yes O No
character and have never been convicted of ri
Signature of Person Conducting Investigation Title S ~ ~ c:~
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 he 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 [he Games of Chance Licensing Law.
9. If applicable, the rent to be paid to an authorized games of chance lessor is reasonable.
l0. Other findings: (Specify)
® Yes ^ No
® Yes ^ No
C~ Yes ^ No
~ Yes ^ No
~ Yes ^ No
L~ Yes ^ No
)~ Yes ^ No
~ Yes ^ No
D 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 ^
12-15-11 Signature of
Filing date of Application Authorized Officer
(Municipal Licensing Authority)
~ Town Clerk
Date i f o~ Title
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 FII2ST AUTHORIZED LICENSE PERIOD.
LBJ-GC-4 (Rev. 4/03) Illlllllllilllllllllllillllll ~
~•GC-2
v
NYS RACING & WAGERING BOARD
l Watervliet Ave. Ext., Suite 2
Albany, NY 12206-1668
Telephone {518) 453-8460 Fax (518} 453-6492
www.racing.atate.ny.us
FOR OFFICE 1 1 2 1 0 1 1-1 $ ?5.00 1 2 / 1 6 ~ 1 1
USE ONLY Munici al License N umber Pees Received Date
a
APPLICATION FOR:
PLEASE CIiBCK
GAMES OF CHANCE ^
BELL JAR `~C
RAFFLE ^
,.,
#1'
frr ~ _~ `~ ~~~ ~,'
': ~~ r,~..y-: ~ h~i.
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITS MUNICIPALITY
GC - [~ - ~ I ~ o ~ ~ 1 ~ z b
N.Y.S. Idendficatton Number
IT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN IBIS APPLICATION
~awt~ c~(r' W Av~P i v~ G~Z ~t~.'T'C.%~S
Kame of Municipality County
PART A. GENERAL
1. Name of Organization
2. Address ;2(oG~ ~ ~t ~-vv S ~ Z ~ ~ C:7
3. Has applicant ever been denied a games of chance licenser ^ Yes ~" 1'o If "yes", why? (Attach extra sheet if necessary)
4. Check type of organization and, if applicable, give the State and date of incorporation.
Corporation ^ Date m ~ m ~ W
Incorporated Association ^ State incorporated
Unincorporated Associations Staff incorporated Date ~ / m ~ m
Individual ^
5. Did your corporate status change since your identification number was assigned? ^ Yes ~No
6. Are you doing business under a trade name? ^ Yes ~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. Z16fo0 ~,~ i h•tl~rt ~ Si l~ irtl-1`-1 ~ 2_
8. Name and address of authorized games of
chance lessor renting to applicant.
9. Does the applicant own the premises? ~Y'es ^ No If "yes", how long?
10. Capacity for public assembly of premises presently owned or occupied. ~ 1
I I. Have premises been regularly used? Yes ^ No If "yes", how long? ~ ~ yP~'+'R-S
Are games of chance being played now on these prerrtises or has it ever been?Yes ^ No If "yes", give full details.
12. Are the premises or any part thereof If "yes", state the type of license and number.
where games of chance are w be played J'~Yes ^ No Gam( ~ ' ~ S~~ c~
licensed by the State Liquor Authority? IL1
13. Has such license ever been ^ Yes
revoked or suspended? .
If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
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NAl-~ CAF AiJX~.TARY/APPS.~A18 C~A~rtBS OE= t~IANC~ ID NUMBER.
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 Nishts 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
(Linut: 5 Games)
LIST THE MAXIlVItJM AMOUNT OF PRIZES
TO BE AWARDED FOR EACH TYPE OF
GAME OF CHANCE (GAME BANK)
at $
at $
at $
at $
at $
For Merchandise Wheels, Beil Jars and Raffles, please complete the appropriate spaces below.
MERCHANDISE WHEELS:
THE TOTAL AMOUNT OF PRIZES POR
Il~IDICATE NUMBER OF EACH MERCHANDISE WHEEL SHALL:
MERCHANDISE WHEELS NOT EXCEED $10,000 AND NO SINGLE
(NO LIlVIIT) PRIZE SHALL~EXCEED $250
BELL JAR:
THE TOTAL AMOUNT OF PAYOUTS
INDICATE IF THIS APPLICATION FOR EACH BELL JAR DEAL SHALL NOT
IS FOR A BELL. JAR EXCEED $3,000 AND NO SINGLE PRIZE
LICENSE SHALL EXCEED $S00
YES NO O
INDICATE IF THIS APPLICATION
IS FOR A RAFFLE
LICENSE
YES ~ NO
IF YES, LIST RAFFLE DATES, TIlVIE(S)
OF DRAWING(S) AND PRIZES IlV
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
IlVDICATED IN SCHEDULE 5
~.~~..-. ..~ a= mvunminai ~
TOWN CLERK
Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W W W.TOWNOFWAPPINGER.US
(845) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-1478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
December 16,2011
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, New York 12601
Dear Sheriff Anderson:
SUPERVISOR
Barbara A. Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Joseph P. Paoloni
Enclosed, please find a copy of "Members in Charge" for Knights of Columbus #1646,
2660 East Main Street, Wappingers Falls, New York, who will be selling BELL JAR
Tickets on their premises throughout the year 2012.
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,
..~
Christine Fulton
Town Clerk
Town of Wappinger