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• <br />is <br />(city or town) ,✓ <br />ANNUAL REPORT - RAFFLES & BAZAARS )(i� <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <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 />Names & Addresses of Winners of $25.00 or More: <br />$ rP.75O <br />$ <br />$ 3�f1 <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report is true and complete. <br />1. <br />2. <br />Accountant) <br />3. <br />Report Certified to be <br />in Conformity With <br />C. 8 ,Acts of 1969: <br />City/T wl Clerl <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, 12/91 H&W Hoeas&WARREN <br />