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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $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 /> ............M <br /> 4L i�... rr.Apu............................... <br /> .................... ........................... ....................................................................................................................... <br /> q ! <br /> Evidence of Qualification for Permit: <br /> E] (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 /> E] (b) Church or religious organization or, <br /> E] (e) Fraternal or fraternal benefit society; or, <br /> (d) Educational or charitable organization; or, <br /> F-1 (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 /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> ......................................... ....... ..-...M.M. ".1 <br /> 0.1 <br /> (2) ...8.y�!COLY17N-qyj&4..1........................................................... ............... ..... ......... <br /> (3) ... .................................. .......................... ..................... <br /> Uses to which net proceeds will be applied: .................................................................................................................. <br /> .................................................................. r-si��Am&............................ . ..................... <br /> ............................................................................................................................................................................................... <br /> .A.,. o ri.ed office, or�.emb,,-/oi organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> Cit1./Town­Cle*rk------ <br /> J <br /> PERMIT (ISSUED) (DENIED) <br /> .......-LL;.. . .i...... .... .......... The. applicant (is) (jm=neH qualified to operate ralfles and <br /> (date)... bazaars under the provisions of C. 810, Acts of 1969: <br /> .......... <br /> City/Town Clerk <br /> ...................... <br /> FORM 810 HOODS & WARRrN INC, <br />