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• <br />y or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS /: /�6 OQ <br />(C. 810, Acts of 1969) �e) <br />Name and address of Nonprofit Organization: <br />Expiration Date of Permit: // /.' <br />If <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 $500.00 or More: <br />(Attach Additional Pages as Necessary) <br />$ dp�94 /0 <br />$ 77L IM <br />We, the undersigned, do hereby certify that this report is true and complete. <br />(Accountant) <br />Report Certified to be <br />in Conformity With <br />C. t 10, Acts of 1969: <br />City/Town Clerk <br />2. A`u)41 e r�Y d Ai <br />3. �vvtoS/A U <br />f <br />Signre of thorized Officer <br />odMember 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, mast submit a Copy of this Report to the Massachusetts State Lottery Commission.) <br />FORM 812 RKv. H Hoass& WARREN TM <br />OVER <br />