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i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <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 /> ! ' Pee-------- -t-Less---------f�SOeI-Al 1 AN <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 /> ❑ (b) Church or religious organization; or, <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> ❑ (d) Educational or charitable organization; or, <br /> f� (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 /> 13-1�-t h-�ti--- - � ho N j- RA;- 01JV. ��----0 A----oa ------ <br /> (1) Q `�9 <br /> (2) ------ --� I---CAfP'.I-gch -RA� �1l8SkPf?P----�_} A----- fla�y�------------------------ <br /> ` ��nQ �� ,,tt-- �y <br /> (3) 4.aRRt�� o ---- 1 - �/�!_.Pn Rk _ �1 -._lam� A�lYJ4 _l-hr- A-----dol(o-y --------- <br /> Uses to which net proceeds will be applied- -------- -- -- ------------------------------------------------------------------------------------------- <br /> ------Yq W_j--------------------------------------------------------------------------- <br /> ------ -------------------------------------------------a6X_U_ <br /> ------ <br /> (signature of authorized officer or member ofor anization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969 <br /> City/Town Clerk <br /> . ,i <br /> PERMIT (ISSUED) O <br /> i <br /> __YA6;- --______1aq-5-_______ The applicant (is) (is-iet) qualified to operate raffles and <br /> (date) > r) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town Clerk <br /> ---- ....... - •••- ...... <br /> -- ---- .............. <br /> Chief ice <br /> FORM 810 1"1OBBs & WARREN, INC. <br />