Wappinger ElksI
GC-5
NYS PACING Bc WACL-'RING BOARD
1 Droadway Center, Suite 6(1U
Schenectady, NY ] 2305-2553
Telephone (518) 395-1400 Fax {518) 347-1469
www.racing.state.ny.us
LICENSE TO CONDUCT
GAMES OF CHANCE
PLEASE CHECK
GAMES OF CHANCE C~
BELL JAR ^
RAFFLE ^
G'C- 1 3- 2 1 9- 6 0 2- 0 1
N.Y.S. ldentifcation Number
C~ 1 2 0 3 1 $ 125.0
Municipal License Number Amount of Fee Paid Lessor's License Number
The following organization:
,~ ""' ~~
:. J../.. ~.. ;
. ~~~~
This License Must Be
Conspicuously Displayed
During Conduct of Games
Address: Route 376 City: Wa~p;ng~rG ~'a11 G Zip Code: 12590
Entire net proceeds to be devoted to the following specific lawful purpose(s):
1/3 Charitable- 2/3 Operations
Names of Members in Charge
Paul Bader
Simon Kaufman
Lewis Hakim
GreE Sarno
LICENSE PERIOD
DATE DAY OF WEEK HOURS
2/03/12 7:OOpm-11:59pm
3/02/12 7:OOpm-11:59pm
4/13/12 7:OOpm-11:59p,
5/04/12 7:OOpm-11:59pm
6/01/12 7:OOpm-11:59pm
TYPE(S) OF GAMES
RAFFLE DRAWING (Cash or Merchandise Prizes
DATE DRAWING TIME DRAWING LOCATION AMOUNT OF RAFFLE PRIZES at Fair Market value)
THE MAXIMUM AMOUNT OF PRIZES TO BE AWARDED
FOR EACH TYPE OF GAME OF CHANCE
3 $ 500
Nl1MBER OF GAMES EACH GAME (Staving Bank)
THE TOTAL AMOUNT OF PRIZES FOR EACH BELL JAR
DEAL SHALL NOT EXCEED $~,D00 AND NO SINGLE-PRIZE
;SHALL EXCEED $500.
Issued by Town of Wavpineer
(Name of Municipality)
12/27/11
(Date)
THE MAXIMUM AMOUNT OF PRIZES TO BE AV~~ARDED
FOR EACH MERCHANDISE WHEEL
NUMBER OF WHEELS EACH WHEEL
GAMES SHALL BE PLAYED IN ACCORDANCE WITH -~
STATE LAWS AND RULES AND LOCAL ORDINANCES OR
LAV,~S.
Chr~ st-1n F ,1 ran Town C erk
(Tit Authorized Officer)
(Signature of Authorized Officer)
IIIIIIIIIIVIII(~II'IIIIIIIII
TOWN CLERK
Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 1259()
W W W.TOWNOFWAPPINGER.US
(845) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-1478 -Fax
Office of the Town Clerk
January 5, 2012
New York State Racing and Wagering Board
1 Broadway Center, Suite 600
Schenectady, New York 12305-2553
Subject: Games of Chance License- Wappingers Elks #2609- 2012
SUPERVISOR
Barbara A. Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Michael Kuzmicz
Please find enclosed the GC-2, GC-2A, GC-2B, GC-4, and GC-5 for the Wappingers
Elks #2609 for the year of 2012.
~--
r
Christine Fu on
TOWN OF WAPPINGER
Town Clerk
Town of Wappinger
1
GC-2
NYS RACING & WAGERING BOARD
1 Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (518) 395-5400 Fax (518) 347-1469
www. racntg. state. ny. us
APPLICATION FOR:
PLEASE CHECK
GAMES OF CHANCE
(Casino Nights, Bazaars, Carnivals)
BELL JAR ^
RAFFLE ^
(only raft]es w/ over $30,000 net profits in calendar year)
.~ ,
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,. ~
~,
.,:~sjpw"~.. ~
FOR OFFICE 1 2 0 3 $ 125.00 1 2~ 2 7~ 1 1
USE ONLY Municipal License Number Fees Received Date
INSTRUCTIONS: PLEASE FILE THREE SIGNED COPIES WITH MIINICIPALTTY
Gc-~3- ~. ~ - ~ v a- o ~a i 3
N.Y.S. Identification Number
TT IS A MISDEMEANOR TO MAKE ANY FALSE STATEMENTS IN THIS APPLICATION
I oW~ o F CJAPP~-vG,E2.s Utz, ic~,Ess
Name of Municipality County
PART A. GENERAL
1. Name of Oraaniz
2. Address ~ ' ~.~ ~ 0 ~ T~ 3 ~ ~ LJ /~ p 1°JJ'~ G,EIL /'~/~ ~ Z -S ~/ Y . /02.5 9 D
3. Has applicant ever been denied a games of chance license? ^ 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 ^
State incorporated JV,EW O ~' ~ Dated ~ ~ d j ~ ~f
Incorporated Association
Unincorporated Association ^
State incorporated
Individual
Datem/m/m
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. f j 9.5 IPOV~~ 3 ~~ l~~/~~-JGti2 `q 1.15 /~,~
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 long? ~ 7 yCA~.S
10. Capacity for public assembly of premises presently owned or occupied. ;2ff(y
11. Have premises been regularly used? ~ Yes ^ No If "yes", how long? ~ ~ yF/~ks
Are games of chance being played now on these premises or has it ever been?[Yes ^ No If "yes", give full details.
A ST" o~ 1 C ~IJS ,E IJ ~EC~NOfYL. ' -~~ ~O / l
12. Are the premises or any part thereof
where games of chance are to be played I~,Yes ^ No
licensed by the State Liquor Authority?
13. Has such license ever been
revoked or suspended? ^ Yes
If "yes", state the type of license and number.
C ~ _ aZ d0 So q~/
If "yes", why? (Explain on a separate sheet, if necessary, and attach.)
L~No
Lv~,,~•,~, _.,. ~. ~9RIII~IIIIIIV~ J
1
PART C. PURPOSES OF GAMES
' 14, State the spec'fic purposes for which the entire net proceeds are to be devoted and in what manner.
3 ch' ,e~ A6~~ a oP~~rioNs
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 chanco 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 beheld,
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 of the Games of Chance Licensing Law, the Rules and Regulations of the N.Y.S. Racing 8t Wagering Board and with the provisions
of local licensing ordinances or laws.
S, 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 tto 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.
r z l m l ~ l ~ l~~k ~ ~~~o
Date Si tore of Head f Organization Print Name
STATE OF NEW YORK
COUNTY OF ~U G~i!~S SS
CITY/TOWNMLLAGE OF /J YL
~`"( ~~ / ~~ being duly sworn deposes and says that (s)he is the person above named,
t (s he has 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. ~'j
Sworn to before me this ~ day of ~~. 20 f /
Notary Public
My Commission expires / 3 i 20/~
CHRISTOS V. SOTIRELIS
NOTARY PUBLIC-STATE OF NEW YORK
No. O1 SO4606940
9uallfled in Westchester ou y
Filed In Queens C%u ,
My Commisslon Expires .
L~°~-° ~a•-~~- III~IIIIAII~I J
1
GC-4 FINDINGS AND
NYS RACING & WAGERING BOARD DETERMINATION
l Watervliet Ave. Bxt., suite 2 FOR GAMES OF CHANCE
Albany, NY 12206-1668 ~ -
Telephone (518) 453-8460 Fax (518) 453-8492 LICENSE ~ -
www.racingstate.ny.us
GC-~- 2 1 9- 6 0 2- 0
N.Y.S. Identification Number Municipal License Number
Town of Wappinger Dutchess
Name of Municipality Count
W a p p i n g e r E l k L o d g e 2 6 0 9
Name of Applicant Organization
R C)iltp 376 , Wapnin~ers Falls NY 12590
Address
After investigation, and a hearing if required under Sec. 192 of the General Municipal Law, the following findings and determinations
have been made:
I . All the members-in-charge designated in the applica ' n to conduct
character and have never been convicted of a crime
Signature of Person Conducting Investigation
are of good moral t~ Yes ~ No
TitleR~s S ~e~~--
2. Applicant is a qualified authorized organization as2le~ined in the Games of Chance Licensing Law.
3. All the members designated in the application to conduct games aze 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 [he 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)
~J Yes ^ No
fl Yes ^ No
~1 Yes D 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 12 / 27 / 1 Authorized Officer
/ (Municipal Licensing Authority)
Date ~7 ~~2 - Title Christine Fulton 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 WAGERING BOARD FIVE DAYS PR10R TO THE FIRST AUTHORIZED LICE`NS`E PERIOD.
L BJ-GC-4 (Rev. 4103) III II IIII~ I II III IIII II I ~~ Ilfl
TOWN CLERK
Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W WW.TOWNOFWAPPINGER.US
(845) 297-4158 -Main
(845) 297-5771 - Direc[
(845) 298-1478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
December 27, 2011
Adrian Anderson, Sheriff
150 North Hamilton Street
Poughkeepsie, NY 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 the members of the Wappinger Elks #2609,
Route 376, Town of Wappinger, who will be conducting Games of Chance
on February 3, March 2, April 13, May 4, and June 1 of 2012
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,
Christine Fulton
Town Clerk
CF/j f
,:
GC-2A APPLICATION FOR GAMES OF CHANCE LICENSE
NY5 RACING & WAGERING BOARD ~,
l Watervliet Ave. Ext., Suite 2 ~
Albany,hTY 12206-1668
Telephone (518) 453-8460 Fax (518) 453-849?
www.racing.state.ny.us
WAPPI NGE R ELKS. LODGE 2609
Name o~"Organization
C- 1 3- 2 1 9- 6 0 2 - 0 2 0 1 3 ~~~~~ r" u'
G ~ ~ ~~
NYS Identification Number Date
SCHEDULE 1: OFFICERS AND DIRECTOP.S
ast names, addresses and dates of biRh of all ofGcxrs.
f organisation is a corporation, or an incorporated or unincorporated association, list officers and directors.
. ~J,E NAME NtO DA ~ OF B~ TH I STREET ADDRESS ( CTI'I' I
I ~~ ~ ~ ~ ~ I
i I / ~ I I
I ~ ~ I ~ _ I
I I ~ I
I ~ ~ ~ I
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. I I / ~ I I
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I~ ~ I I - i
~ ~ ~ I I I
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Attach additional sheet if necessary.
SCHEDULE 2• MEMBERS IN CHARGE OF GAMES
(MUST LLST AT LEAST FOUR MEMBERS OF APPLICANT ORGANIZATION)
DATE YEARS OF .
NAME ~ OF BIRTH MEMBERSHIP STREET ADDRESS CTI'Y I ZIP
( ~ ~ I - I_
aul Bader I 9/ 20 / 1965 I 14 I 134 Anderews Rd I t~Grange I ' 12540
Simon Kaufman I 8 / 16 ~ 1930 I 7 9 S yew t n _ _ I Hopewell Jet I 12533
Lewis Hakim I 7 / ~2Z_ / _.1445.. I ~ - ( I WaoginpP'~ F~u~ I '__.:__~°n--
I 7 / Ol / 1936 I Z_ I 1~ rlar~a PI^ro I I ',=596
Greg Samo
/ ~ I ~I
/ / -
I ~ ~ -I' --
SCHEDULE 3: AU~'ILIARY/AI'EILIATE ORGANIZATIONS ASSISTING AT GAMES
• (MAX.^.vIUt.9 OF 2 AUXILIARIES/AFFILIATES. EACH AUXILIAP.Y/AFFILIATE LISTED MUST HAVE 1TS OWN 1D NUMBER.)
NAME OF AU~'II-IARY/°,.F~~I. IATE GAMES OF CHANCE ID NUMBER
Paoe I of 2
VIIVI!~IIIIII!IIII'iIl~iPi J
I3J-GC-2A (Rev. 4/03)
Officers_Report201112151535
Schedule 1 -Officers and Directors
OfficeHeld FirstName LastName DOB Address
Exalted Ruler Mark D'Angelo 3-Aug-49 17 Forrest Way
Leading Knight Christopher Leahy 17 Partners Trce
Loyal Knight John Sorrell 27-Ju1-64 7 Hujay Ter
Lecturing Knight Anthony Manzo 3 Dorett Dr
Secretary Robert Acquanita 25-May-42 10 Vomdran Dr
Treasurer Pamela Kultsar 1-Feb-50 58 Hillis Ter
trustee -One Year James Boyer 28-Nov-37 134 Andrews Rd
Trustee -Two Year Rocco Valente 6-Jun-41 61 Fishkill Hook Rd
Trustee -Three Year James Golding 25-Aug~6 256 Lakeshore Dr
Trustee -Four Year Atex Czamiecki 16-Oct-41 31 Helen Dr
Trustee -Five Year Max Dao 31-Dec~3 2 Dwyer Ln
Tiler Susan Dorler 29-Mar-39 21 Valley Rd
Esquire Mark Fox 15-Sep-57 28 Tiger Rd
Chaplain - Catherine Rohling 22 Apr-40 54 Brothers Rd
Inner Guard Margaret Harten 2-Jan-37 20 Valley Rd
Poughkeepsie NY 12603-3840
Poughkeepsie NY 12603-3265
Wappingers Falls NY 12590-5822
Wappingers Falls NY 12590-2204
Wappingers Falls NY 12590-4517
Poughkeepsie NY 12603-5812
Lagrangeville NY 12540062
Hopewell Jct NY 12533416
Pleasant Valley NY 12569-5605
Wappingers Falls NY 12590-1705
Wappingers Falls NY 12590-4806
Wappingers Falls NY 12590-2105
Hopewell Jct NY 12533-5037
Wappingers Falls NY 12590-3414
Wappingers Falls NY 12590-2106
Page 1
SCHEDULE 4
List all members o
.
MEMBER NAME
s~~ f3TTi9G/~~y : ASSISTANTS TO MEMB
f applicant organization and members of authorized
member of applicant organ
YEARS O
DATE OF BIRTH MEMBERS
l l ERS IN CHARGE OF GAMES
affiliates and auxiliary who will assist with games. Each person listed must
ization or affiliate for at least 1 year.
F
HIP STREET ADDRESS CITY
be a
ZIP
I I I
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B,T-GC-2A (xev. 3/06) 4 Attach addition
Pa al sheet if necessary.
ge 2 of 2 IIII II II I IIIIIII I III I III)
~ it '
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 04/2411940
Philip A. Abbate 6 Hackensack Hghts Rd Wappingers Falls 18 05116!1937
Robert Acquanita 10 Vorndran Drive Wappingers Falls 22 05/25/1942
Ralph J. Anzivina 12 Thorns Lane Highland 22 12/21/1935
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 07/1811946
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 09/15M957
Harris C. ~ Jones 217 Brothers Road Stormville 18 04/24/1944
Robert J. Juliano 2776 West Main Street Wappingers Fails 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 0710111936._ _;, ,.
Kenneth J. Tucker 34 Pawling Lake Pawling 9 .-
Robert N. Wailner 7 Kinry Road Poughkeepsie 19 01/1711933.. .
1
GC-2B
NYS RACING & WAGERING BOARD
1 Broadway Center, Suite 600
Schenectady, NY 12305-2553
Telephone (S 18) 395-5400 Fax (S 18) 347-1469
www.racing.state.ny.us
APPLICATION FOR GAMES OF
CHANCE LICENSE
,~.
'~ ~. ~.e
.~
~ _
'~. ~.
I~/I~ I~ I PI ~ I^~I~I~ ICI I~I~ IKIsI I~- I~ I~ I~IEIaIGI~ig I
Name of Organization
GC- /.3- 02 1 - tea, - D ~ o /3 / ,~ l /~/ l l
NYS Identification Number Date
SCHEDULE 5 DATES, HOURS AND RENT OF ALL LICENSE PERIODS TO BE HELD
(NOT APPLICABLE FOR BELL JAR GAME,S~
DATE HOURS RENT
06t. / . 63 / la, ! .7.: oo am/~li - // ~' Jam~!~
b~ / Off. / ~.Z I am/pvm - am/pm I~
~ y / /3 / / ~, I am / pm - am / pm I
~ S / ~ / /.Z. I am / pm - am / pm I
O (o / a~ / / ~. ~ am / pm - am / pm !
/ / I am / pm - ~ ~~ / pm I
/ / ~ am / pm - am / pm ~ ~ ~_
/ / I am / pm - am / pm i
. / ` . / ~ am / pm - am / pm ! ~ `
/ / I am / pm - am / pm I
/ / ~ am / pm - am / pm I
n.. .
TIlvIE PRIZES
I of Merchandise)
/ / / m - m ~
/ / ~ ~/ am/pm I
•
~
/ / ~ am/pm - I
/ , • am / pm - am / pm
. I
/ i am / pm - am / pm
~- I
SCHEDULE 6 EXPENSES
List items of expense to be in curred, and the names and addresses of persons to be pai d.
ITEM OF EXPENSE VENDOR NAME $~'REET ADDRESS CITY STATE ZIP
L BJ-GC-2B (Rev. 3/06)
Page 1 of 2
YS~IIIIIIIIII~ J
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 NiEhts 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)
Q~.19Ck ~C/L
~x~~ ~°~~~n
/~
/J ~ G S j X (~ l~ljy'Yt L
LIST THE MAXIMUM AMOUNT OF PRIZES
TO BE AWARDED FOR EACH TYPE OF
GAME OF CHANCE (GAME BANK)
at $ ~Up . D O
at $ Soo . o 0
at $ S(> O. O a
at $
at $
Merchandise Wheels, Bell Jars and Raffles, please complete the appropriate spaces below.
iANDISE WHEELS:
THE TOTAL AMOUNT OF P FOR
TE NUMBER OF EACH MERCHANDISE SHALL
ISE WHEELS NOT EXCEED $10,000 O SINGLE
(NO L T) PRIZE SHALL EXCEE 250
BELL JAR:
T TOTAL AMOUNT OF PAYOUTS
INDICATE IF THIS APPLICATION OR EACH BELL JAR DEAL SHALL NOT
IS FOR A BELL JAR EXCEED $3,000 AND NO SINGLE PRIZE
LICENSE L EXCEED $500
YES ^ NO ^
RAFFLES:
INDICATE 1F THIS ICATION THE TOTAL AMO F PRIZES FOR
IS FORA FLE ., ALL THE RAFFLES CO TED DUR-
L NSE ING THIS CALENDAR YE SHALL
S ^ NO ^ NOT EXCEED $100,000. NOS LE
IF YE IST RAFFLE DATES, TIlvIE(S) PRIZE SHALL EXCEED $50,
DRAWING(S) AND PRIZES IN EXCEPT THAT A SINGLE PRIZE OF
SCHEDULE 5 $100,000 MAY BE AWARDED IF SO
INDICATED IN SCHEDULE 5
L.,~°°~ ,n, .•..a, ~IIIMII~YINNWI
J