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0 k <br />city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS 7 Z, c2w <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <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 />a <br />$ 1;? -70 <br />r r!I <br />• <br />Names & Addresses of Winners of $500.00 or More: <br />A3 nlAa <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this <br />K00-104"w?�_ -_— (Accountant) <br />- <br />Report Certified to be <br />in Conformity With <br />C. 810, Acts of 1969: <br />• City/Town Clerk <br />Signature of Authorized Officer <br />or Member of Organization <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&WARREN TN <br />