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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> ......................... s P .... <br /> (city or town) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> i <br /> Name and address of Nonprofit Organization: <br /> .........4......C. .rT............</A5..-----•---•................................................ <br /> ..... �*Yxyr4 . a6 i� <br /> Evidence of Qualification for Permit: <br /> i <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, I <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 /> shareholder. <br /> Officers or members of organization responsible for operation of raffle or bazaar: <br /> Name Residence Address <br /> O --{-✓_�...lfwrtk/J- i9�- 7 T11 .................1 .d.:....! ox._% vv.... hlAV&., �E o2 6 <br /> 1 <br /> r�I22f'r i� ye <br /> .. s(� &/o9'" �i"45'e <br /> (3) .............................1..._... ....�.Y�,3---------------- !uir---------............ ... B <br /> Uses to which net proceeds will be applied: ......... s>I!� ...... ���'7°� ......... ................. <br /> /' .......L'.A .......�t✓!`�5............................................................... <br /> ...............•.............................•-----.........................................................-----..........._....-----......................................•...............--- <br /> (ei'gna au o"rized officer or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969, <br /> City/Town Clerk <br /> i <br /> PERMIT (ISSUED) (DE=) <br /> ...... ...... The applicant (is) (iffiqtet) qualified to operate raffles and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town Clerk <br /> G? ....................... <br /> ... . . . .. ..... .... <br /> Chie of lice , <br /> .? FORM 810 HOBBs a WARREN, INC. <br />