1983-VARIETY OF YEARS-RAFFLES AND BAZAARS - BOOK-TAN ALPHABETICAL WOMENS ETC

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THE COMMONWEALTH OF MASSACHUSETTS FEE $10.00 ---------------------------�� ` --------------------------------------------------- (city or town) " APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS (C. 810, ACTS OF 1969) Name and address of Nonprofit Organization: Evidence of Qualification for Permit: ❑ (a) Veterans'organization chartered by the Congress of the United States or included in clause (12) of section five of chapter forty of the General Laws; or, ❑ (b) Church or religious organization; or, ❑ (c) Fraternal or fraternal benefit society; or, ❑ (d) Educational or charitable organization; or, ❑ (e) Civic or service club or organization; or, �(f) Club or organization organized and operated exclusively for pleasure, recreation and other nonprofit purposes, no part of the net earnings of which inures to the benefit of any member or shareholder. Officers or members of organization responsible for operation of raffle or bazaar: I Name Residence Address -----------------------------% � �� (2) ---)�-`-�_C_!!a -KN---------------------------------------------------- ------- Uses to which net proceeds will be applied: _ __ _.__ ` __��r � -__�-- - � -------------------------------------------------------------- -------------- ------------------------------------------------------------------------------------------- ------------ 4 ----- n-,-o -------- ------(signature of authorized oember f org z on) Application certified to be in conformity with C. 810, Acts of 1969: p City/Town Clerk PERMIT (ISSUED) (DENIED) M• y_,_1- �5______________ The applicant (is) ( qualified to operate raffles and (date) bazaars under the provisions of C. 810, Acts of 1969: City/Town Clerk ------------------ ----•---------------- --------------•-•- Ch olice FORM 810 1-Io BHS & WARREN, INC.