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-4 <br /> I o��caca <br /> 1 <br /> (city or town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> t (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: <br /> *7_9/j C,,EN iW�J_ 8 A 0 -/LSHIF,�c <br /> `J q <br /> ' Expiration Date of Permit- <br /> Number <br /> ermit Number of Raffles and Baneetrs Held: &V11X_ <br /> Amount of Money Received: $ <br /> � 7 <br /> c Expenses Connected with Raffles Conducted: $ -7' <br /> Net Proceeds: $ <br /> R; For What Purposes Were The Proceeds Used? <br /> Names & Addresses of Winners of $25. 00 or More: <br /> J <br /> r <br /> (Attach Addition Pa/es J Necessary) <br /> We, the undersigned, do hereby certify that this report is true and <br /> complete. <br /> 1• ',. G <br /> v" <br /> c i 2. <br /> ( ccountant) 3. <br /> Report:Ce TIM <br /> in Confor i M <br /> C. 810, Acts of 1969: <br /> Signature of Authorized Officer <br /> or Member of Organization <br /> CityA;j wn Clerk <br /> HPU TOWN1 CLOWTHIS REPORT <br /> RENEWAL PERMIT WILL OT BE ISSUED TO LICENSEE UNTIL <br /> r1 'DT FTV <br />