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I <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> - --------- --•------------------------- <br /> • •(city or town ) p � <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of Nonprofit Organization pY <br /> ------- OX------ -------fir -------- --24.---... fit- 1� --------O.Pk.._...----- - 2-6y� <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 /> ❑ (d) Educational or charitable organization; or, <br /> ❑ (e) Civic or service club or organization; or, <br /> i <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 /> -7 11 <br /> (2) ..._.. <br /> 41 "X <br /> �J `1. 1 ��Lccxj� _,Ll`I- _ lsc '��,J <br /> (s> _ .._......... _______________ `_._ . .------•-•-__.__._.___ __3tJ 1f��..._____ fsf -Z'-_'1 ....�s�... <br /> Uses to whic net proceeds will be applied: --•-•-. S. <br /> -----------------------Atureof •••••--•-•----•----•--------•••--•-••-•-•••--•-•-••---•-------••---------•---•-- <br /> (sigborized officer or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> I� <br /> ------------ <br /> City/Town Clerk <br /> .i <br /> A <br /> PERMIT (ISSUED),� , <br /> I <br /> ... _,_I-C11 li�_2 ......... The applicant (is) (4&-xe4) qualified to operate raffles and <br /> 6 date) bazaars under the provisions of C. 810, Acts of 1969: <br /> GLV.L ta'"t— <br /> . .................... <br /> City/Town Clerk <br /> c. <br /> JL.- hief of <br /> I <br /> FORM 810 HOBBS & WARREN, INC. <br />