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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> I-<_ - S ••-_pR I <br /> (city or town) <br /> E ; APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> i_ (C. 810, ACTS OF 1969) <br /> t <br /> Name and address of Nonprofit Organization: <br /> ...---:Po---150 '--5500.-�C 0----K- ------ -eaira;�Y --C :_.�...[1n t� <br /> Od04 01 <br /> Evidence of Qualification for Permit: <br /> ❑ (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 /> ❑ (b) Church or religious organization; or, <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> ® (d) Educational or charitable organization; or, <br /> ❑ (e) Civic or service club or organization; or, <br /> ❑ (f) Club or organization organized and operated exclusively for pleasure, recreation and other <br /> 'M nonprofit purposes, no part of the net earnings of which inures to the benefit of any member or <br /> �F <br /> shareholder. <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> 1 =------------- E <br /> (2) C.�r1kl-Aw w. )50642P.1.... O-Q5.--------- �-----.MOA AIM <br /> (3) ��.6-wa-5 <br /> Uses to which net proceeds will be applied: •_______________________ <br /> -•-•- ------------ • , ----- - - - <br /> �€ ----------•---------------Y_!-l_l__ .C�..�_:���------U`�--��.... ?�i--- -�Ylso-_�'�C..� � �ClsI/1 rJ`P.�Q,,,._•----------------- <br /> ------.M O�o � t r a gi <br /> x <br /> a'n ........................................................ ---- ............................... <br /> (signature of authorized officer or member o rganization) <br /> Application certified to be in <br /> X conformity with C. 810, Acts <br /> of 1969 <br /> City/Town Clerk <br /> PERMIT (ISSUED) (DENIED) <br /> � � �g _� � <br /> ________ ________/_______ ............... The applicant (is) (4+-aet) qualified to operate rakes and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town clerk CURTIS W. FRYE <br /> d <br /> ......................... ............................................. <br /> ef <br /> F OfflWeOF POLIO <br /> MASHPEF <br /> FORM 810 HOBBS &WARREN, INC. <br />