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i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> ------------------------------------------------------- <br /> (city or town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name a d address of Nonprofit Organization- <br /> ..... <br /> rganization <br /> �Ek ► cG t- -V �► Y _ .w----- C-I.Q-b---------------------------------------------------- <br /> 'o ��------_---1-1.3� ,�..�_Z'�C�_z�'�� A <br /> j <br /> ------------------------------------ <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 /> ❑ (e) Civic or service club or organization; or, <br /> N�/(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 /> 1 � � --- <br /> �. <br /> h. <br /> ,s�c-i -- <br /> Uses to which net proceeds will be applied: _ ) c2v_---___ 1 <br /> --.a <br /> L <br /> ------ <br /> JC( <br /> ....---4g.' .aure ed of a orizof& r member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969 <br /> City/Town Clerk <br /> PERMIT (ISSUED) ( D) <br /> .. .Q •1--9 ° The applicant (is) (is iak) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town Clerk <br /> --- ---------- ! ---- ....... ......... <br /> 6 ief o oli <br /> FORM 810 HOeeS & WARREN, INC, <br />