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OISI'1 CAGE.. <br />—� (city or town) ` <br />ANNUAL REPORT - RAFFLES & BAZAARS /A 1J 90, a o) o <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <br />Aga 6 Obl sL �0 o 6\ yo\ sl Pee_. <br />Expiration Date of Permit: <br />Number of Raffles and Bazaars Held: <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposes Were The Proceeds Used? <br />Names & Addresses of Winners of $500.00 or More: <br />(Attach Additional Pages as Necessary) <br />$ D(O aaC .coo <br />$ \O , 531.0 • o <br />of ,V?4 . oo <br />r v GS <br />We, the undersigned, do hereby certify that this report is true and complete ±o i 6c. < Jd O<+/ Gln .^' 2e�Cfrr <br />1. <br />z. U.x► d st l 41�s _ teh17o, o <br />(Accountant) <br />Report Certified to be <br />in Conformity With <br />C. k101 Acts of 1969:. <br />Signature of Authorized O ' er <br />or Member of Organization <br />City/Town-Clerk <br />• <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.) <br />OVER <br />FORM 812 Rev. H&W HoBBs B wARRENIM <br />