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THE COMMONWEALTH OF MASSACHUSETTS <br /> FE <br /> ......................... 6 <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 /> T------------- --------- 0JA( 0 f1111 /k <br /> -------------------*......*----------------------------------------- <br /> ------ ....... ... ----------- -------- -VVA........a2j�a 4'? <br /> Ma- <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 /> F-1 (c) Fraternal or fraternal benefit society; or, <br /> [f (d) Educational or charitable organization; or, <br /> EvE] e) Civic or service club or organization; or, <br /> g (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 /> 4 <br /> .....jk .. . 15 �cc"C� <br /> ................0_4..04 ... ..vim ---- ----------- <br /> ..M-W-oUXL qok................ <br /> (2) --------tv,�� <br /> ............... <br /> /5 ------- <br /> --- ---------------V-II)- -----------------3 <br /> (3) ---i <br /> jalc(��- ...............�-� .1--- --------------- ---- K-CAOyp <br /> Uses to which net proceeds will be� applied - ------ ........... <br /> ------- - ------All <br /> .. ... ......... <br /> ..............................................................----------------------------.......................................................................................... <br /> ..................................... <br /> Application certified to be in (signature of t 411, -1 ember r-g-a n--i z--a-tii-o-n--)------------------ <br /> conformity with C. 810, Acts <br /> of 1969 <br /> City/Town_6 ie-rl----------- <br /> PERMIT (ISSUED) (DENIED) <br /> a-9-3 K2, <br /> -------------------IV......... ..................... The applicant (is) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> V <br /> . <br /> City/Town Clerk <br /> .............................. <br /> iie of olive <br /> FORM 810 HOS13S & WARREN, INC. <br />