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0 <br />• <br />• <br />Nam, <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />(ci 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 />❑ fd) 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 />(1) <br />(2) <br />Uses to which net proceeds will be applied: ope- \UYICt �X(JenSeS <br />Application certified to be in <br />conformity with C. 810, Acts <br />of 196 <br />City/T wn Ctecd <br />. 1121171 <br />FORM 810 REV. 12/91 Hi Hoses &WARREN rm <br />(signature of authorized officer or <br />The Applicant (is) (is <br />bazaars under the on <br />of <br />qualified to operate raffles and <br />ps of C. 810, Acts of 1969: <br />of <br />OVER <br />