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NOTICE OF ISSUANCE OF: <br />RAFFLE AND/OR BAZAAR LICENSE <br />CITY OR TOWN .......................... C c <br />ud,bl..� .cct1 e ........................ — <br />NameolAulMnzedOrganizalion J <br />Co81crim,o�rlhC_<..� "!'�...n1Ctshpee...1��... <br />AddresslSlrcep Cily/Tewn _"r\/ gIgODE <br />F— FORM IS TO BE RETURNED TO: OFFICIAL <br />BEANO DEPARTMENT SEAL: <br />Massachusetts State Lottery <br />P.O. Box 800 <br />L BRAINTREE, MA. 02184 <br />RBL PRINT IN INK, OR TYPEWRITE <br />25M ]E7 <br />• <br />0 <br />IDENTIFICATION NUMBER DATE RECEIVED <br />COMPLETE AND SIGN THE REVERSE SIDE <br />