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poWt 812 1106DS 6 WARREN INC. i <br /> _ I <br /> he— <br /> city town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: i <br /> Expiration Date of Permit:--- f ! <br /> Number of Raffles and Bazaars Held: , <br /> Amount of Money Received: <br /> I <br /> Expenses Connected with Raffles Conducted: $ 70 <br /> Net Proceeds: $ <br /> For What Purposes Were The Proceeds Used? <br /> I <br /> t ' <br /> i <br /> Names & Addresses of Winners of $25. 00 or More; <br /> /L <br /> i <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify that this report is true nd complete. <br /> ii <br /> �- <br /> i <br /> i, <br /> (Accountant) .y. <br /> 3. <br /> Report Certified to be j <br /> in Conformity With <br /> C, 810, Acts of 1 <br /> V <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 Holders also holding Beano Licenses,must submit a Copy of this Report to the Massachusetts State Lottery Commission.) Revised January 1974 <br />