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FolUl 812 IHSS d WARREN INC. <br /> ('clt/y('cit/yor town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> (C. 810, Acts of 1969) (datel <br /> Name and address of Nonprofit Organization: i <br /> �'f,� 0 � &X A�e &SIS <br /> Expiration Date of Permit: <br /> Number of Raffles and Bazaars 'Held: <br /> Amount of Money Received: <br /> a <br /> I <br /> !7h <br /> oc Expenses Connected with Raffles Conducted: <br /> ai <br /> Q, <br /> 0 <br /> aNtrt Proceeds: <br /> of <br /> a3 <br /> Wh <br /> fG For What Purposes Were The Proceeds Used? <br /> ZI <br /> P <br /> Name & Addresses of Winners of $25. 00 or More: <br /> Ma, (OVIIJV9 <br /> 1jtnc-V—ftha6!� 12�, <br /> (Attach Ad 'tional Pages as Ne essary) <br /> We, the undersigned, do hereby certify that this report 's true and complete. <br /> ! <br /> (Accountant) <br /> 3. <br /> Report Certified to be <br /> in Conformity With <br /> C• 10, Acts of 1969: <br /> Signature of Authorized Officer <br /> or Member of Organization <br /> City/Town Cl r <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 Rnlders also hnldinv Reann Licenses.must submit a Coov of this Renort to the Massanhllsetts State I nttery CnmmisOnn 1 Ravieed Iannary 197A <br />