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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> -----­---------------- ............. C ------------------- ..................... <br /> (city or (town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810., ACTS OF 1969) <br /> Name and address of onprofit Organization: <br /> ................................................ ................................... <br /> ...... ........ cq�,.ka ------AU... ...................... <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 /> F, (b) Church or religious organization; or, <br /> f--j (c) Fraternal or fraternal benefit society; or, <br /> (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 not 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 /> (2) ------------------------ ...................................................................................................... <br /> Ala-c, 4a ---_-------- --------------------------- --- -------­-----------­--- <br /> .................. .................................. ....... <br /> Uses to whil net proceeds will be applied: ------0__ ------ <br /> ----7- <br /> ............................. -------------------------­--- ----------------------------------------------------------------------------­---------­.­... ................ ...... <br /> ...................... ........................................................................................ .......................... ................................................... <br /> .......... .......... ----------------------------- <br /> si rof <br /> authorized officer or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> q,- ........ IT— <br /> City/Town Clerk <br /> PERMIT (ISSUED) (DENIED) !i j <br /> ------------------ The applicant (is) (is not) qualified to operate rules and <br /> (date) bazaars under the provisioiis of C. 810, Acts of 1969: <br /> .......... <br /> City/Town-n*---Clerk_-___------------------- <br /> ........ .. ........ <br /> Chief of Police <br />