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FORM 812 LOUDS a WARREN INC. <br />)r <br /> (city or town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS C, �- - <br /> (C. 810, Acts of 1969) (date) <br /> Name and address <br /> of Nonprofit Organization: <br /> I <br /> i <br /> Expiration Date of Permit: ©V <br /> Number of Raffles and Bazaars Held: <br /> Amount of Money Received: $ <br /> Expenses Connected with Raffles Conducted: $ Q <br /> Net Proceeds: $ <br /> For What Purposes Were The Proceeds Used? <br /> Names & Addresses of Winners of $25. 00 or More: <br /> IL <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify that thi�q repo true nd complete, <br /> 1. <br /> . f <br /> 2, ? <br /> (Accountant) 3, <br /> Report Certified to be <br /> in Conformity With <br /> C. 810, Acts of 1969: <br /> Signature of Authorized Officer <br /> or Member of Organization <br /> ity/Town Clerk <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 /> (Permit Holders also holding Beano Licenses,must submit a Copy of this Report to the Massachusetts State Lottery Commission.) Revised Ja <br />