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i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> ---MAS/.i-ipwr'--------------------------=-------------------- <br /> (city or town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of Nonprofit Organization: <br /> --------- ----- =19-).r .l._ <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 /> i <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> Xr(d) Educational or charitable organization; or, j <br /> ❑ (e) Civic or service club or organization; or, j <br /> ❑ (f) Club or organization organized and operated exclusively for pleasure, recreation and other j <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 /> ----`�-------- c-) ;' R-� ................................... 51��'� <br /> (2) l ----- 5--- _ <br /> f <br /> Uses to which net proceeds will be applied: ---------------------------------------------------------------------------•----------------------------------- <br /> --------- C !- — 1 J r -k.--------. ---------------------- <br /> 1 <br /> (signature of aut d officer or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> City/Town Clerk <br /> :I) <br /> PERMIT (ISSUED) ( ) <br /> ,a I qg(b <br /> C•___________________________ The applicant (is) (`1a= } qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town Clerk <br /> •... - ie - --------------•------------ <br /> I <br /> Chie o P- iee � <br /> FORM 810 HOBBS & WARREN, INC. <br />