Laserfiche WebLink
city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS c,2 - /f-06 <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <br />r^ <br />Expiration Date of Permit: /l—n27 —0-�j <br />Number of Raffles and Bazaars Held: / <br />Amount of Money Received: $ d2�7 <br />Expenses Connected with Raffles Conducted: $ /5 <br />Net Proceeds: $ ZOY <br />For What Purnoses Were The Proceeds Used? <br />Names & Addresses of Winners of $25.00 <br />Additional Pa)'es as <br />We, the undersigned, do hereby certify that this re) <br />1. <br />2. <br />(Accountant <br />Report Certified to be <br />in Conformity With <br />C. 810, Acts of 1969: <br />• S .7�/.' <br />Ci[y/To n Cle <br />(.44� A- XV /0"y) <br />or Member 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, must submit a Copy of this Report to the Massachusetts State Lottery Commission.) <br />OVER <br />FORM 812 REV. 12/91 H&W HOBBS a WARREN'" <br />