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NOTICE OF ISSUANCE OF: <br />RAFFLE AND/OR BAZAAR LICENSE <br />CITY OR TOWN ..........................� <br />LlAUIT, Izd OrganizationLb <br />`L' Lf <br />L'? , C-1 YANS`\gCIF I 'MAI <br />. _... <br />Address (Street) City/Town ZIP CODE <br />F— FORM IS TO BE RETURNED TO: <br />BEANO DEPARTMENT <br />Massachusetts State Lottery <br />P.O. Box 800 <br />L BRAINTREE, MA. 02184 <br />RBL PRINT IN INK, OR TYPEWRITE <br />25M-7-83 <br />I FOR MASSACHUSETTS STATE LOTTERY COMMISSION USE ONLY I <br />OFFICIAL <br />SEAL: <br />IDENTIFICATION NUMBER I DATE RECEIVED <br />Date sue:J4 6n <br />6—) <br />City/TownO /tial <br />�D <br />Tille <br />014-- <br />COMPLETE AND SIGN THE REVERSE SIDE <br />