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i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> --------------1Q�---OX---lashge-e----------------------------------------------------- <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 /> ------------------ <br /> T`ahee hions Flub <br /> ---------- ------r= BOX--.-3-9-1-------C/-o----Marden-_Kelley--rsa.s4ee,-- ---------- <br /> Evidence <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, <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> i <br /> ❑ (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 /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address i <br /> (1 ----------� a�}•yy��nd--I-:i..,�,.y . - _ 't (, <br /> l ) J""^" O�+.'�..��-----------�,o-�.�-_��:1t-e --s�jF'�.-r---tYA��+i._?-E�}{�-s�-.T---�1��---�:�-.--��1-•------•-------------------------- <br /> O -illiam i alis G-I i� t 's� s- 49. <br /> 2 e.:._- ick � -- x-- �--, h -- -- �. <br /> C�26 <br /> (3) ... a'at`' } -----. t? 'QT1 ,v I_=ash �e t II2u_ <br /> --------------------------- <br /> Uses to which net proceeds will be applied: -------------------------------------------- -----------------•--------•---------------•--------••------- ----- <br /> eye research <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- <br /> ----- <br /> i <br /> ignature of authorized officer or member of organization) <br /> Application certified to be in , <br /> conformity with C. 810, Acts j <br /> of 1969: <br /> -----------------=- = <br /> City/Town Clerk <br /> y t <br /> PERMIT (ISSUED) (DENIED) f, <br /> � � - The applicant (is) (is not) qualified to operate raffles and <br /> (dat}) bazaars under the provisions of C. 810, Acts of 1969: <br /> ---------------------- <br /> City/Town Clerk '- / ��. <br /> �= <br /> I C— <br /> Chief of Police <br /> FORM 810 HOBBS & WARREN, INC. <br /> I <br />