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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> --------------------- -- ..... .............UA..................................... <br /> it ty or town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of Nonprofit Organization- <br /> C I <br /> ..............------- ........ ---------------------------------------------------- <br /> ------ ...... <br /> -------------------------- ------ -------------------------------------------------------- <br /> Evidence of Qualification for Permit: <br /> E] (a) Veterans'organization chartered by the Congress of the United States or included in clause (12) <br /> of section five of chapter forty of the General Laws; or, <br /> E] (b) Church or religious organization; or, <br /> E] (c) Fraternal or fraternal benefit society; or, <br /> F (d) Educational or charitable organization; or, <br /> F (e) Civic or service club or organization; or, <br /> '(f) Club or organization organized and operated exclusively for pleasure, recreation and other <br /> nonprofit benefit n <br /> .. Xrofit purposes, no part of the net earnings of which inures.to the be e t of any member or <br /> shareholder. <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> ........................ <br /> (1) --------------------------------------------------------- -A b- <br /> .......... . . . ........... <br /> (2) ----------- ----------------------------- vu.... <br /> - <br /> (3) - V <br /> ..... .......... ............................... &A <br /> V ---------------------------- <br /> tt <br /> Use to which net proceeds will be applied ..... If - R-1 -c- <br /> ------------------------ <br /> ................Q*.C-L ... . ... <br /> ...........V�a_-�rz- ------------------------------------------ <br /> "I--------- ------- --------- ------------------ <br /> ..................................... ... .... ... ..... ----- ---------- <br /> (signature of auth i officer or memberof o ani ation) <br /> ?i <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 196 <br /> City/Town Clerk <br /> PERMIT (ISSUED) <br /> ................. The applicant (is) (i&7n"t) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> --------q. Of Y19'.a—I—OLA <br /> City/Town Clerk <br /> ...............&a ... .... ........................... <br /> cQ4� e <br /> Chie <br /> FORM 810 HOBBS & WARREN, INC. <br />