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FORM 812 IIORRS 6 WARREN INC. <br /> (city r(town) <br /> ANNUAL REPORT - RAFFLES & BAZAARS T- j`1S <br /> (C. 810, Acts of 1969) (date) <br /> Name and address of Nonprofit Organization: <br /> I <br /> Expiration Date of Permit: <br /> .1 <br /> Number of Raffles and Bazaars Held: <br /> Amount of Money Received: $ <br /> i <br /> Expenses Connected with Raffles Conducted: $ l 7 L15 <br /> Net Proceeds: $ ,� /j- <br /> For <br /> -For What Purposes Were The Proceeds Used? <br /> Names & Addresses of Winners of $25. 00 or More: j <br /> (Attach Additional Pages as Necessary) <br /> We, the undersigned, do hereby certify thatis repo s tru d cornplete. <br /> 2. � <br /> (Accountant) <br /> 3. <br /> Report Certified to be <br /> in Conformity With <br /> C. 810, Acts of 1969: ynh'u�u�'(rl <br /> �}- Signature of Authorized Officer <br /> �l?� XJ1 or Member of Organization <br /> ity/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 /> (Permit Holders also holding Beano Licenses,must submit a Copy of this Report to the Massachusetts State Lottery Commission.) Revised January 1974 <br />