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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> Mashpee $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 /> The Carney.-Hospital <br /> ------------------------------------------------- --------------- -------- --•--------•... ------•-------•-------••---••--•••-•--•••-•---•-•-•-••......-••-•-••------ 5� <br /> 2100 Dorchester Avenue, Boston, Massachusetts 02124 <br /> ---- <br /> f 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 /> ❑ (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 /> f shareholder. <br /> f <br /> i <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> E <br /> L 1O JohnW. Logue — 8 Skyview Road, Randolph, MA02368 <br /> ----••---• -- ------- _- -- - - - ------------ - • ----- -- ------ ---- --- . -- ---- <br /> ...... <br /> (2) __ Paul A, Vielkind - 14--Bayberry___Lane. Randolph,__MA.--_02368--__ j <br /> (g) Thomas J. Devane 144 Main Street, Waltham, MA 02154 <br /> ------------------ -------- -------- <br /> Uses to which net proceeds will be applied: __..Proceeds_ to help purchase new equipment at the <br /> ------------------------- -------- ------------_-------- <br /> Carney Hospital, a 416_-bed health care facility sponsored by .the__Daughters of <br /> - -- <br /> Charity of St. Vincent de Paul <br /> ------------------------------------------------- <br /> 1 <br /> President <br /> 6iure of.authorized offi or, member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: <br /> C -----J-------_------------ <br /> City/Town <br /> --\J-— ----- <br /> City/Town Clerk <br /> i <br /> PERMIT (ISSUED) (DENIED) <br /> -m <br /> Mk4• .-Q__-._.!..................... The applicant (is) (iaxet) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town Clerk <br /> -------- ----_ ------ <br /> Chief of Police <br /> c>r <br /> FORM 810 HOBBS & WARREN, INC, <br />