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FOIUI 812 LOBUS 6 'n,.?:hEN INC. 77 <br /> 7- <br /> 1 <br /> (city or town) <br /> 4 <br /> ANNUAL REPORT - RAFFLES & BAZAARS <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: <br /> 411, <br /> Expiration Date of Permit: <br /> Number of Raffles and Bazaars Held: <br /> i <br /> I <br /> Amount of Money Received: $ 2k'J 'd. <br /> Expenses Connected with Raffles Conducted: <br /> Net Proceeds: <br /> 4 <br /> For What Purposes Were The Proceeds Used? <br /> af bt e"i.y.«-C ofe re /o a <br /> at. <br /> Names & Addresses of Winners of $25. 00 or More: <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify that this report is true and complete. <br /> i <br /> 2 <br /> (Accountant) <br /> Report Certified to be <br /> f` in Conformity With <br /> C. 810, Acts of 1969: ,Q <br /> i <br /> I <br /> Signature of Authorized Officer <br /> or Member of Organization <br /> City/Town Clerk <br /> RENEWAL PERMIT WILL NOT BE ISSUED TO LICENSEE UNTIL THIS REPORT <br /> HAS BEEN COMPLETED AND FILED WITH THE COMMISSIONER OF PUBLIC SAFETY. <br /> in""'` °"'a"'^ ^I^^ti Mill Q—,r irnncnc mutt cuhmif 2 Cnnv of thic Rannrf to tha Maccachncattc Ctatn I nttrry Cnmmicsinn.l Revicad lanum 1974 <br />