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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 Nokiprofit Organization: <br /> Rotqp- ------------------------------------------------------------------------------ <br /> ---------- <br /> tqko-5-clq&� 195 1p ............................................................... <br /> --------- - f...... t....M <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 /> is <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> (d) Educational or charitable organization; or, <br /> F-] (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 /> ....co-Ci2-fT— ------------------- ............ <br /> D . .. ................................... <br /> (2) ......L(�14A f i--7 - <br /> �e -----------------------------76--1-1R� cok�,---koa AN <br /> (3) ------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ <br /> Uses to which net proceeds will be applied: .....Bho-g.----- ------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------- <br /> ----------------------------------------------------- --------------------------------------------------- <br /> ---------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- <br /> --------- ...................— <br /> ember of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969:. <br /> City/Town. Clerk <br /> PERMI (DENIED) <br /> fj1A91Ch-.1A 4-1119JO........ ......---- The applicant (is) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> .......... <br /> City/Town Clerk <br /> .. ... ................... <br /> Chief o Po e <br /> FORM 810 HoBas & WARREN, INC. <br />