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(edm � <br />• k- <br />- <br />T (' y or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS 7 "� <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <br />Expiration Date of Permit: 5--�23 —0 <br />Number of Raffles and Bazaars Held: l <br />Amount of Money Received: $ 4WV - UL.) <br />Expenses Connected with Raffles Conducted: $ SO • 00 <br />Net Proceeds: $ 16 70 • &D <br />For What Purposes Were The Proceeds Used? <br />• <br />Names & Addresses of Winners of $500.00 or More: <br />�At <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that t <br />ccountant) <br />Report Certified to be <br />in Conformity With <br />C. 810, Acts of 1949: <br />• City/TowCI <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 $12 Rev. H&W Homs& WARREN Tu <br />