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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE-------------------- <br /> I b <br /> (city or t wn) <br /> APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br /> (C. 810, ACTS OF 1969) <br /> Name and address of Nonprofit Organization: <br /> Gad V <br /> ------ ----- '--�- <br /> ` .... k . <br /> ----- <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 /> i <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 /> I <br /> (1) <br /> .......... '6/0.&R-b-----------.6WIc- <br /> ......................---•-•---------•---------- <br /> ' J <br /> (3) --------- ------- <br /> 4/0/&---F ---- ' '� C <br /> Uses to which net proceeds will be applied: .......................................................................... <br /> -----------------------------------------------------•------•------------------------------------------------.------------ ------------ ------ <br /> -------------------------------------------------------------------------------------------------------------- <br /> ------ -- ---.. <br /> SL t/ ` <br /> ----------------- I <br /> sign re o authorized officer or em er of organizati ) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 1969,E <br /> 4-ft- -"C�'Li-t-Py- <br /> _ �'-------•--- <br /> /Town Clerk <br /> PERMIT (ISSUED) (DENIED) <br /> f �. ,►� 1 <br /> ............. The applicant (is) fit-) qualified to operate raffles and <br /> �(date) bazaars under the provisions of C. 810, Acts of 1969: <br /> City/TownClerk <br /> Chi of oliee <br /> :: JRTIS . FRYE <br /> L` OF POLICE " <br /> FORM 810 HOBBs & WARREN, INC. <br />