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THE COMMONWEALTH OF MASSACHUSETTS j <br /> FEE..................... ..W-4ff <br /> I a d a <br /> (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 /> 0 IK <br /> scs <br /> i <br /> ------------------•----•---------...--••••----------••••-- <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, <br /> ❑ (b) Church or religious organization; or, <br /> ❑ (c) Fraternal or fraternal benefit society; or, <br /> E?,"(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 /> I <br /> Name Residence Address <br /> (1) ..._L "r -........ --- q11--------�(,d i---..... <br /> .....5- fl2 rn 1 c cs <br /> (2) _..G1.6_x� " -G 6`� J -, �c ��,1/i. �1iL9- fes <br /> ----------- --------- <br /> p ------------------- �- <br /> (3) ----1! /'rCt _ <br /> 3 <br /> Uses to which net proceeds will be applied: ---------------- ---------------- .........................----- ' <br /> tdNn/"9-- fj' y------ ------- 5= ......moi_... e+Qso,-y <br /> -------------7 'J'i n1 d "`!z4?? <br /> ----------------------------------------------------------------- <br /> g G:--( -------------------------------------- <br /> i na ure of Lorized officer or mem er of organization) ! <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969: �p <br /> �(NhR city/Town Clerk <br /> I <br /> PERMIT (ISSUED) (DENIED) <br /> -------- U _ _)7- 1 q ; <br /> i <br /> i................... The applicant (is) (.�s-�e�t) qualified to operate raffies and <br /> (date) bazaars under the provisions of C. 810, Acts of 1969: <br /> GvY�p - iY� <br /> -- ---------- <br /> City/Town Clerk <br /> Chlef o P ice <br /> ------•-------•- <br /> CURTIS W. FRYE <br /> CHIEF OF POLICE <br /> FORM 810 HOBBS & WARREN, INC. MASHPEI: <br /> J ti <br />