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r; <br /> M <br /> THE COMMONWEALTH OF MASSACHUSETTS i <br /> FEE <br /> j (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 /> �'rJ T .-►�c..1!V-w Y' <br /> -- <br /> --------------------------------------------------- ------ <br /> I P 0 13-bx °Me s hl_11 SHIVt 1= -WA <br /> •-- , ------------•-- i <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, <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 /> �l ~ o.74,t1,9,: 5�-'---------------------- <br /> ��---`--'�--..�-��*��----+--��� �.��_��-v?'-------IAT s�pia, kid <br /> --------�P`� �l✓?•r_. Q-cgL��_�sE'171<�1-�� �� U.��J� <br /> (3) r " Ic ------------------- r° o e X y73_/ C1°f" f ✓�1 zs— <br /> Uses to which net proceeds will be applied: -----------------------------.. <br /> . .--....N....._ J�1 y <br /> !' ---------------------------------------------------- <br /> i <br /> ---------------------------- <br /> Application certified to be in (aignature of authorized officer or member of organization) <br /> conformity with C. 810, Acts <br /> of 1969: (� <br /> City/Town Clerk <br /> 7 <br /> PERMIT (ISSUED) (DENIED) <br /> ----- - - ------ The applicant (is) qualified tooperate raffles and <br /> ) (�� q <br /> fbazaars under the provisions of C. 810, Acts of 1969: <br /> City/Town Clerk <br /> ------ -•-- <br /> Vef­ <br /> o olive <br /> CURTIS W. FPY" ` <br /> CHIEF OF phi`.:;::..;: <br /> MASHPIff <br /> FORM 810 HOBBS &WARREN, INC. <br /> i <br />