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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> ............................. ..............g e <br /> --------------------------------------------------- <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 /> -2 <br /> ........... ------- -------- -------------- <br /> ........................................-AA..... .......... P...... 2S........ <br /> -11* ................. <br /> Evidence of Qualification for Permit: <br /> ❑ (a) Veterans'organization chartered by the Congress of the United States or included in clause (12) <br /> of section five of chapter forty of the General Laws; or, <br /> F-1 (b) Church or religious organization; or, <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> ❑ (d) Educational or charitable organization; or, <br /> (e) Civic or service club or organization; or, <br /> F,—1 (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 /> 2) <br /> -------------- f------------ nlr le-------------- <br /> �'2 <br /> ...................... <br /> ............ <br /> Uses to which net procee s will be applie�. ........................... <br /> ------ -------------------------------- <br /> ---------------- <br /> ............ <br /> ......... . ... .. <br /> ...................... ------ - ------- ------ <br /> (signature of authorized officer or member of oganization) <br /> Application certified to be in <br /> conformity with C. 310, Acts <br /> of 1969- <br /> .. ......................... <br /> City/Town Clerk <br /> PERMIT (ISSUED) (DENIED) <br /> .........—Curl..__._. The applicant (is) (4s-net) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town Clerk <br /> ... ........ .......................... <br /> Chief o of <br /> ORM 810 FI BBS WARREN, INC. <br />