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FORM 812 LOBOS G WARREN INC. <br /> h <br /> Egz <br /> (city or own) <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> � I <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization- ,1 <br /> 1 119, - �9/Z <br /> Expiration Date of Permit: <br /> Number of Raffles and Bazaars Held: <br /> Amount of Money Received: <br /> Expenses Connected with Raffles Conducted: <br /> Net Proceeds: <br /> I <br /> For What Purposes Were The Proceeds Used? <br /> i' <br /> I <br /> N mes & Addresses of Winners of $25. 00 or More: <br /> ftlo <br /> ?o <br /> (Attach Additional Pages as Necess r QQ <br /> We, the undersigned, do hereby certify that this report is true and comple e, <br /> —Vcc <br /> 3, f'v <br /> Report Certified to be <br /> in Conformity With <br /> C. 810, Acts of 1969: L. r <br /> Signature of Auth tz f' <br /> 1 cti.a SA or Member of Org iia ion <br /> City/Town Clerk <br /> RENEWAL PERMIT WILL NOT BE ISSUED TO LICENSEE UNTIL THIS REPORT <br />