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...Y. a12 40ifaS . 4An t%1::. ::,C. <br /> IZ) <br /> mAS�ff E' <br /> w„�y <br /> (city or town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS - ie; ° 164. 108 <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: <br /> ly�rrc�o nno f-ni on�il n� f'o�mfl i��t TTpi1 ni�n� <br /> I <br /> Expiration Date of Permit: <br /> Number of Raffles and Bazaars Held: <br /> Amount of Money Received: $ <br /> Expenses Connected with Raffles Conducted: $_ 04.45 <br /> Net Proceeds: $ 1242.80 <br /> I <br /> For What Purposes Were The Proceeds Used? <br /> j <br /> /o pYA04cwe elq ci Tent Pt 4Ae fa l wuA Flo-4pi-tC1 <br /> i <br /> I <br /> Names & addresses of Winners of $23, 00 or More: <br /> j <br /> (Attach Additional Pages as 'Necessary) <br /> We, -he undersigned, do hereby certify that Pz '_s report is true and complete. <br /> ,I <br /> 2. <br /> (Accountant) <br /> 3._ } ; <br /> Report Certified to be <br /> '•n 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 aoiders _!,o oidinR ?eano Licenses. nust :vomit -, 'iov :t'!is Revert.7-he massacnusetts Stcte lottery commission.', Revised lanuary'914 <br />