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11 <br /> FORD] 812 110BBS 6 WARREN INC. <br /> i = r <br /> III "r(city or town) <br /> �4 <br /> ANNUAL REPORT - RAFFLES & BAZAARS Qcrtobea 6 1985- <br /> (C. 810, Acts of 1969) (date) .--- <br /> j, <br /> Name and address of Nonprofit Organization: <br /> Expiration Date of Permit: Alm 29, 9985 <br /> Number of Raffles and Bazaars Held: <br /> Amount of Money Received: $ z ( M <br /> Expenses Connected with Raffles Conducted: $ 85.-o0 <br /> Net Proceeds: $ 1579.00 <br /> For What Purposes Were The Proceeds Used? <br /> �0 by# uahee&ni/w, &e l moni.tvn, and 2 "Co►prn ivnpeuonu l <br /> eneVeney aeap nlJego at fa,GnOuiA Ha4p;6zl <br /> i <br /> i <br /> Names & Addresses of Winners of $25. 00 or More: <br /> i <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify that this report is true and complete, <br /> 1• --- <br /> 2, <br /> is <br /> (Accountant) <br /> 3. <br /> Report Certified to be <br /> in Conformity With <br /> C. 810, Acts of 1969: <br /> Signature ' <br /> uthorized Officer <br /> — or Member f 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 Holders also holding Beano Licenses,must submit a Copy of this Report to the Massachusetts State Lottery Commission) Revised January 1974 <br />