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C] <br />(jefty or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS /'-'q'© <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <br />Expiration Date of Permit: 14-67 <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 />$0 <br />4� <br />$� 9/z' -7 <br />$� 3n3.3a <br />Names &Addresses of Winners of $25.00 or More:- <br />,Aa4 z�tc9dt'//' d`�Gr[�S �a/ <br />Additional Pages as <br />We, the undersigned, do hereby certify that this report is true and complete. <br />' 1. <br />2. <br />L) (A nota ) <br />3. <br />Report Certified to be <br />in Conformity With <br />C. 810, Acts of 1969: <br />or Member of Organization <br />City/Town Clerk <br />is <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 Re, 12/81 (H&W HoBass WARREN Tm <br />