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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> (city or town <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of No rofit Organization: <br /> • <br /> • <br /> 46 f <br /> __ ---- <br /> --.4t----- - --IJACIA. . ..... <br /> - - ---- <br /> ---------M 77 <br /> Ql <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, 9A <br /> (e) Civic or service club or organization; or,�b�a k6� P <br /> ❑ (f) Club or organization organized and operated exclusively for pleasure, recreation and oth • <br /> nonprofit purposes, no part of the net earnings of which inures to the benefit of any member or <br /> s are oder. <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> ...dD.0; --------------------------- . ....... <br /> (2) ---- -------17.E-------- ------- -- -- - ----------------------- ----- --�-- -1 - �--- -- - --�js�i•- � <br /> (3)r5 �' 1 t. --- . . rte' <br /> ------ �-./' .^eA <br /> Uses 1 �� <br /> �� �► xi�eeil -------------------------------- <br /> ---- <br /> 5e------------------------- <br /> ---•---- -- ,lc----- --t-ems-- -- <br /> (signature of thorize officer ember of organiza on) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> --- - <br /> City/Town Clerk <br /> PERMIT (ISSUED) (BENMD) ? <br /> ----------C�Gzt�.C3tiR,Zp, t q... d The applicant (is) 1 <br /> -•------•---- pp • ) (aa�et) qualified to operate raffles and <br /> (date) n) bazaars under the provisions of C. 810, Acts of 1969: <br /> .r <br /> z4 City/ own Clerk <br /> ----------•---•---- <br /> Clue f P •ce <br /> FORM 810 HOBBS & WARREN, INC. <br /> i'. <br />