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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> /ours ot�� $10.00 <br /> ............................... .......................... <br /> (city or town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of Nonprolfi-t:tepee 0 izat*,".�A <br /> 7 .= 0, <br /> ................................. .. ................................................................................................................................. <br /> 0. Box Mt 0264q: <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-1 (b) Church or religious organization; or, <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> (d) Educational or charitable organization; or, <br /> ❑ (e) Civic or service club or organization; or, <br /> E3 (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) L 74166�...jj��9. <br /> ...................................... ................................................ <br /> (2) -------------------------------Sua&ey- .0009....................................... <br /> ,.M... <br /> (3) --Beve Ady, ftladhpee�, 6 . . <br /> ..&4—Beme------------------------------ JW....0249.............................. <br /> Uses to which net proceeds will be applied: .................................................................................................................. <br /> ............................................. <br /> ......................................... ....... ............................ <br /> ............................................................................................................................................................................................... <br /> . .......... . . ...... .. ..... <br /> ..................... <br /> �7r o organization) <br /> (signature of authorizqffieer or member f Organiza <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969 <br /> City/Town Clerk <br /> PERMIT (ISSUED) (DENIED) <br /> 4.1 ............. The applicant (is) (4&%Qt) qualified to operate raffles and <br /> (date) bazaars bazaars under the provisions of C. 810, Acts of 1969: <br /> nn <br /> . .......... <br /> City/Town Clerk <br /> ... ............................. <br /> Chief of lice <br /> A <br /> FORM 810 HOSES & WARREN, INC. <br />