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FORM 812 NOBBS 6 WARREN INC. <br /> a <br /> 0- <br /> (city or town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS JR �l°j°�1 <br /> (C. 810, Acts of 1969) (date) <br /> I <br /> Name and address of Nonprofit Organization: <br /> Expiration Date of Permit: AA 1� idyl <br /> l <br /> Number of Raffles and Bazaars Held: <br /> CLAS VF-yS W jNts) <br /> Amount of Money Received: <br /> Expenses Connected with Raffles Conducted: �Qo-1 `J <br /> Net Proceeds: $ 9 1 S o S5 <br /> I <br /> For What Purposes Were The Proceeds Used? <br /> k-(ZAAN 1-159- <br /> Names <br /> -1szNames & Addresses of Winners of $25. 00 or More: I <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify that this repor ,, is true and complete. <br /> I <br /> 9 11 <br /> 2.L—Y'Ut4/11P <br /> i <br /> _r .Accountant) <br /> 3-4- <br /> Report <br /> .Report Certified to be <br /> in Conformity With <br /> C. 810, Acts of 1969: <br /> _ ture of Authorized Officer <br /> or Member of Organization <br /> City/Town Clerk <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.) Revised <br />