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812 1108Os G WARREN INC... <br /> , <br /> (ci y or town) <br /> a� <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: <br /> �T a n.� ("C-AA ep,�h�; � Tc.s "' L v,c <br /> Expiration Date of Permit:_ � ! <br /> Number of Raffles and Bazaars Held; <br /> Amount of Money Received: <br /> Expenses Connected with Raffles Conducted: $ V, 70 <br /> Net Proceeds: $ 36a�3V <br /> For What Purposes Were The Proceeds Used? <br /> I <br /> j <br /> Names & Addresses <br /> of Winners of $25. 00 or More; <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify that this report is true�and complete. <br /> � l <br /> �-- <br /> 1• __ I <br /> (Accountant) I' <br /> 8. lXane <br /> Report Certified to be <br /> in Conformity With <br /> C. 810, Acts of 1 <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 /> TTAO n>,T,T,T ^l"NAN"T T,TL4T% AnTT1 T:TT T:TN ttrTT`T.2 TT.TV fNn11R11RTCCTn'KTV'D n'W VTTVT T(` CQIF!rrV <br />