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• <br />Nam, <br />• <br />THE COMMONWEALTH OF MASSACHUSETTS <br />11010 <br />ihQ���ee <br />(city or town) <br />APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br />(C. 810, ACTS OF 1969) <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 />E"(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 />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 <br />Residence Address <br />Application certified to be in <br />conformity with C. 10, Acts <br />of 1969: <br />City/Town er <br />PETIT (ISSUED) (�" <br />NoVeic�v 13, 2oct� <br />(date <br />City/To n Cler <br />FORM 810 R[v 12191 HAW HOBBBB WARREN'" <br />of au(hized officer or member of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars u der the pr visions of C. 810, Acts of 1969: <br />Chlef of Poh <br />OVER <br />EWA <br />