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/ 1 <br />U <br />0 <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />i G5hpe� <br />1 (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 />gUdi'&L LDe,r\ Le Dae/, Zne <br />1881 � �\mo�kh �, c1 • , C � �� <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 />X (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 />(1) <br />(2) <br />(3) <br />Uses to which net proceeds will be applied: Ce Y14610 re0dNnr7) 5C0J[tL Nur- ihf, <br />Oe t>r,rl�r C\�5F b <br />Name Residence Address <br />Application certified to be in <br />confor 'ty with C. 810, is <br />of 1969: <br />City/Town Clk <br />PERMIT (ISSUED) <br />I <br />(dat <br />c91A�� <br />City/Town Clerk <br />FORM 810 R[v 12/91 CH_ &W HOBBSB WARREN <br />of authorized offitW or member of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions of C. 810, Acts of 1969: <br />Chief of Police <br />OVER <br />