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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> ................... -------.................................................. <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 /> -------------------- ----------------------------------------------- <br /> -------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- <br /> Evidence of Qualification for Permit: <br /> F1 (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 /> F1 (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 /> E] (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 /> ------------------------------------------- &v <br /> (2) ------------------------------------------------------------------------------I---------------------------- <br /> --- ----------------------------------------------------------------------------- <br /> (3) ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- <br /> Uses to which net proceeds will be applied: ........ ------ .1111=...... <br /> 4 <br /> ....... -7?d. f______. <br /> —w.........q................. ----------------------------------- ----------------------- <br /> ----------------------------------------------------------------------- -------------------------------- ...................... ............................................................. <br /> ...................................... ......... ........... . ... ------------------------------------------- <br /> (signature of thorized o cer or emb of organization) <br /> ---------------------- -------------------- <br /> " 'f <br /> Y' 4,e-r o 4r -letm- <br /> f thorized o bfr- <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> .__ <br /> .......... <br /> City/Town Clerk <br /> PERMIT (ISSUED) (DENIED)-------------------------- <br /> The applicant (is) (is a qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> .................. <br /> City/Town Clerk <br /> Chi <br /> —------------- ii�f 0 0 <br /> ..................... ..... ......... ................ <br /> Chi l* <br /> FORM 810 HoaBs &WARREN, INC. <br />