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FORM 812 HOBBS b WARREN INC. <br /> CA4" <br /> (city or town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: <br /> tl—V5—h4'—ae-9 e14 I <br /> Expiration Date of Permit: L?ql <br /> C49 <br /> Number of Raffles and Bazaars Held: <br /> Amount of Money Received: $ <br /> IleExpenses Connected with Raffles Conducted: $ <br /> Net Proceeds: $ ,Oel 30 Od <br /> C <br /> i <br /> For What Purposes Were The Proceeds Used? <br /> /o f <br /> Names & Addresses of Winners of $25. 00 or More: <br /> WlXes . <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify that this report is true and complete, <br /> 2, j <br /> (Accountant) <br /> 3. <br /> Report Certified to be <br /> in Conformity With <br /> C, 810, Acts of 1969: ' <br /> 4 <br /> Signature o Aut ized Officer <br /> or Memb of Organization <br /> it/Town Clerk <br /> RENEWAL PERMIT WILL NOT BE ISSUED TO LICENSEE UNTIL THIS REPORT <br /> RAS 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 January 1974 <br />