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077 <br /> (city or town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS cc(. bq <br /> (C. 810, Acts of 1969) (Ate) <br /> Name and address of Nonprofit Organization: <br /> ac'u Am <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: $ line_ <br /> For What Purposes Were The Proceeds Used? <br /> Names & Addresses of Winners of $25. 00 or More: i <br /> (Attach Additional Pages as Necessary) <br /> , i <br /> We, .he ,ndersigned, do hereby certify that this report :s true and complete, <br /> j 1 <br /> I <br /> 2. <br /> (Accountant) <br /> 3• <br /> Report Certified to be AS14Q� - {(,QT-0. c6onel4, 1:0c. . <br /> ''-n Conformity With <br /> ... 810, Acts of 1969: <br /> Signature of Authorized Officer <br /> ' or Member of Organization <br /> ity/Town Clerk 16 ltg sober / <br /> RENEWAL PERMIT WILL NOT BE ISSUED TO LICENSEE UNTIL THIS REPORT <br /> HAS BEEN COMPLETED AND FILED WITH THE COMMISSIONER OF PUBLIC SAFETY. <br /> �^rmit 'aoiders ;iso holding 3eano Licenses. nust ;uhmit i copy of ,his Report the 4ass3chusetts State Lottery Commission., <br />