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i <br /> i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> --------------------------------- ....................................... - <br /> city town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of Nonprofit Organization <br /> --------------------------------------------- <br /> 11 <br /> - <br /> / � - ----- . . ��s.1_�-•---- ........ -�-------- j <br /> i <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 /> P�(d) Educational or charitable organization; or, <br /> ❑ (e) Civic or service club or organization; or, <br /> ❑ (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) /�/ lel� <br /> (2 ---- S! J� --- -- -C/ � -=��----------------------z ------------ - <br /> (3) ----- <br /> Uses t hich net proceeds will be applied: / ��:� ---- -- ----- - ---- --- ------ <br /> f'° - ---------------- ----------------------------- <br /> ----------------------•------------------------------------------------------------------------------ ------------------------------------------ <br /> -------------------------- ---- --- ----------- ----,----- --- <br /> (signat a of authorized officer or ember of organization) <br /> Application certified to be in <br /> conformity with C. 810 Acts <br /> of 1969: <br /> f City/Town Clerk <br /> i <br /> PERMIT (ISSUED) (B*NtHD) <br /> !-___ -9_`... The applicant (is) (- -xe -qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> Cit /Town Clerk ----------------------- <br /> / <br /> CSL/. <br /> i of oliee <br /> FORM 810 HOBBS & WARREN, INC. <br />