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/11--)97 j7— <br /> THE <br /> T-THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> A"hoee $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 Nonprofit Organization: <br /> -------------A-wh <br /> rganization: <br /> 'eeAzeQtyrcavtfz -------------------------- -------------------------------------------- <br /> ox 1� <br /> -------------� - =------------ d44 ,--lir--a -4�------------------------------------------------------------------- <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, j <br /> ❑ (c) Fraternal or fraternal benefit society; or, j <br /> [3 (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 /> i <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> i! <br /> i <br /> Name Residence Address J <br /> (1) #ezen �c7t21P/L <br /> � �------ ................................................................... <br /> (2) flivte-f`" -e/7 ' ---- ---------�Q --------------m ------------------------------------------------------------ <br /> (3) 1 4nOG O e------------------------------------------------------------- <br /> PPp ----------------------------------------------------------------------•------------------------- <br /> Uses to which net roc ill be applied:: _.&AR_� � <br /> /ourvrd.� erLt orL wofza <br /> -------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------- <br /> (signature authorized r or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: i <br /> City/Town Clerk <br /> alp <br /> PERMIT (ISSUED) (DENIED) <br /> ,I <br /> V a� 1 9 � ____________ The applicant (is) (is-not) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> ,� <br /> City/Town Clerk / <br /> ---• ........ ---- ........................... <br /> Chie of olice <br /> i <br /> FORM 810 HOBBS & WARREN, INC. <br />