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it R <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE 20.00 <br /> ..............1..3..h p e e......................._-.................................................. <br /> (city 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 /> .................** Reople...to... eaple.............................................................. <br /> ...................Pfl...Box...A................................q LQ.._Hew... . Ury...Q..............Mashpee,...A&. 02649 <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 /> L ❑ (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 or <br /> or, <br /> ❑ (f) Club or organization organized and operated exclusively for pleasure, recreation and other <br /> nonprofit purposes, no part of the net earnings of which inures to the benefit of any member or <br /> shareholder. <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> Lionel LeBlanc Gleneagle Drive, Ma.shpee, MA <br /> Pres. <br /> (1) ... - ---------------------- :• --------- _......_.._...__.....- -._.._........... .................-- <br /> (2) ......ChrtoPher_Burden.,...5LPres.._.. Cross Road: <br /> ..Ma hpee, ....... <br /> (3) .....aa=i.Cla..RI 3=11 -i-..Treasurer.... Brassie Wav, Mash-Pee, M <br /> -. .. <br /> Uses to which net proceeds will be applied: ................................••---......---•----.........-•----•---......----..•........--•---•-•-••........... <br /> All proceeds-.w11_.be.dgnated.. 4.. ea..andlQx--Cana-_c'ad_.charities.................... <br /> ............. cznatiQn.-_t.Q .............................. --- --•----•-• -•-•--... -- ...... ..................................................... <br /> ........ •---- .. ..... .. ......... . .• ------••-•--•-•--- ............................ <br /> (signature of an riz eer or member of organize <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 19 <br /> �.I �._ <br /> City/Town Clerk <br /> PERMIT (ISSUED) (D ) <br /> ,i <br /> 161W& 1.......&C16 The applicant (is) (isnatequalified to operate raffles and <br /> (da bazaars under the provisions of C. 810, Acts of 1969: <br /> ity/Town Clerk <br /> Chic! ! olive <br /> ** name change <br /> FORM 810 HOBBs $WARREN. INC. <br />