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• <br />Nam <br />10 <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />rr1251,e- <br />(city & 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 />❑ (d) Educational or charitable organization; or, <br />❑ (e) Civic or service club or organization; or, <br />X- (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 />Use <br />Name Residence Address <br />Application certified to be in <br />conforripty with C. 810, Acts <br />of 1969 <br />City/Town let <br />PERMIT (ISSUED) <br />6 -11,q -b9 <br />�(daatntee) <br />LCA <br />City/Town CIA <br />FORM 810 Rev. 12/91 H HOR8s8 WARREN'm <br />The Applicant <br />bazaars under <br />(is not lified to <br />rov'sions <br />Chief of olice <br />raffles and <br />of 1969: <br />OVER <br />