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THE ,COMI-1011WEA1,'1'll OF MASSACHUSE"I"I'S <br /> tYl ASGi .��. 1'C ff <br /> T O 14 N OF I��}'moi-1`E $ 10 . 00 <br /> r <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> t{, (C . 810 , ACTS OF 1969) <br /> ;,Name and address of Nonprofit Organization: <br /> Christ the King Parish <br /> n , - n Q P .0. Box 1;0 0 Gettii-t, MA 0 2 6 YI <br /> Evidence of Qualification for Permit: , <br /> ❑ (a) Veteran's organization chartered by the Congress of the United States or <br /> included in clause (12) of section five of chapter forty of the General <br /> 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 /> ❑ (a) Civic or service club or organization; or, <br /> ❑ (f) Club or organization organized and operated exclusively for pleasure, <br /> recreation and other nonprofit purposes, no part of the net earnings <br /> of which inures to the benefit of any member or shareholder. <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> NAriE RESIDENCE ADDRESS HOME PHONE NUMBER <br /> 3, (1�LCL't/•� �� /Yl//s �d �►/�rl �r.�t /�ry /'�i,t���„c f�71- 7770 <br /> (2)_�lrGi�R. lfr� L3 <br /> Ml Xe Os%r.�yi//t v 71 <br /> (3) r r �/tr?4- 2,7 A h llfl e lAvbt )%.r4,re z <br /> Uses to which net proceeds will .be applied: V- 1^-A-4/�r <br /> C 444 .v� Tc del mix. ole- 12- <br /> Names and addresses and phone numbers of person(s) leasing gaming equipment to the <br /> Organization: <br /> Iefe- t <br /> Current list of the-members of the Organization and addresses: <br /> MEMBERSHIP LIST SHALL BE ATTACHED TO APPLICATION <br /> No person holding a permit to operate raffles or bazaars shall operate any particu- <br /> _ lar such event unless written notice has been given to the Chief of Police, not less <br /> than thirty (30) days prior to the event, of the date, time, and place of the event <br /> of any deviation from the information contained in the application for the per- <br /> mit to operate the same. <br /> _,Any person violating any provision of this article shall be punished by a fine of <br /> "not more than $300. 00. <br /> (signature of authorized officer or member of organization) <br /> Application certified to be in <br /> conformity with C.810, Acts of <br /> 1969 <br /> R iS F E <br /> Town Clerk PGS <br /> PERMIT (ISSUED)) (DENIED) D <br /> +, 77 <br /> 4 * The applicant (is) ( ) qualified to operate <br /> (date) raffles and bazaars under the provisions of C. <br /> 810, Acts of 1969: <br />