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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> ....ax <br /> ------------------------------------------------------------------ <br /> gjff�i"ity 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 /> .......V�F��Vs........... ................................................... .............. <br /> .......G.0 k........... <br /> Evidence of Qualification for Permit: <br /> Ej (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] (c) Fraternal or fraternal benefit society; or, <br /> E] (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 <br /> 4 �-z....... —------------------------ -------- ------------ <br /> (2) ----------------- <br /> .. ................,.....1� - 21 <br /> (3) - ----------- ------ -------- <br /> ---------------- <br /> WMZ ----------06- <br /> Uses to whic net proceeds will be applied: --------- ----------------- --- <br /> ............V,...... ....... Y--- ---C�----------- <br /> -------------------------------------------------------- -------------------------------------------- ---- --------------------------------------------------------------------------------- <br /> . .........I---------- .................................................. <br /> ---------------------- - ----------- - I <br /> (sigAtureof thorized officer or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> ---------- ---- --------------- <br /> - -.� <br /> City/Town Clerk <br /> PERMIT (ISSUED)-tUdOMFXt� <br /> YYl at The applicant (is) qualified to operate raffles and <br /> -a---------- <br /> -date --------- <br /> bazaars under the provisions of C. 810, Acts of 1969: <br /> -City/Town----Clerk------------- --------- <:-- <br /> .. ............ <br />