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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> ----------------------------------T014414 OF TVAOIT <br /> (city or town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of Nonprofit Organization: <br /> ,i <br /> -------------------------------------------------------------------'"iy3J----"""'---�4.hi._L.--------------------------- <br /> 130X 337, Hashpee, Nass. <br /> --------------------------------------- -- ---------------- --------------------•--••---•----- <br /> 1' I <br /> Evidence of Qualification for Permit: <br /> ❑ (a) Veterans'organization chartered by the Congress of the United States or included in clause (12) I <br /> of section five of chapter forty of the General Laws; or, i <br /> ❑ (b) Church or religious organization; or, <br /> ❑ (c) Fraternal or fraternal benefit society; or, a <br /> l <br /> ❑ (d) Educational or charitable organization; or, <br /> �-] (e) Civic or service club or organization; or, <br /> ❑ (f) Club or organization organized and operated exclusively for pleasure, recreation and other <br /> nonprofit purposes, no part of the net earnings of which inures to the benefit of any member or <br /> shareholder. <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> --------------------------------- <br /> ------------------------------------------------------------- -------------------------------------------------------- ........ <br /> (2) <br /> ----- -- <br /> (2) <br /> (3) ------------------------------------------------------------------------------- -------------------------- <br /> Uses to which net proceeds will be applied: -_T.Q--- '�h etheJav7 O Life I <br /> ---------------------------------------- <br /> i <br /> ---------------------------------------------------- <br /> (s(gn re of authorized officer or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> �>�y/ 'own G�lerk <br /> PERMIT (ISSUED) t +ED) , <br /> The applicant (is) (is not) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> (3ity/Town Clerk <br /> ----------- <br /> -- <br /> --------- <br /> Chi of Police <br /> FORM 810 HoBSS & WARREN, INC. <br />