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FORM 812 LOBBS 6 WARREN INC. <br /> V <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: <br /> j <br /> Expiration Date of Permit: /%/ /'.�/�T•, <br /> Number of Raffles and Bazaars Held: <br /> Amount of Money Received: $ :2,-9' s <br /> Expenses Connected with Raffles Conducted: $ <br /> Net Proceeds; $ C2 , ,T <br /> For What Purposes Were The Proceeds Used? <br /> aw <br /> O 7- <br /> Names <br /> i <br /> Names & Addresses of Winners of $25, 00 or More: <br /> — 6I ff�'os-ti',�� OL�zrre�.r; rg <br /> (Attach Additional Pages as Necessary) 13oX 13 42� lypt <br /> We, the undersigned, do hereby certify tha is report is ue complete <br /> 1, <br /> 2, 1 <br /> (Accountant) <br /> 3, ///Gh <br /> Report Certified to be <br /> in Conformity With <br /> C, 810, Acts of 1969: <br /> Signature of Authorized Officer <br /> or Member of Organization <br /> City/Town Clerk <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 Holders also holding Beano Licenses,must submit a Copy of this Report to the Massachusetts State Lottery Commission.) Revised January 1974 <br />