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THE COMMONWEALTH OF MASSACHUSETTS <br /> FEE <br /> $10.00 <br /> ----------- ------------------------------------------------------------ <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 /> ------------- ....... ------ ----------------- <br /> ...... ----- <br /> 7 <br /> ............... <br /> -- - -- ----- -------------- -------- <br /> Evidence of Qualification for Permit: <br /> E] (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 /> F-1 (e) Fraternal or fraternal benefit society; or, <br /> X(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 /> Lt <br /> ...Dc.m-ue� ----------------------1Q------ --------011-clt Pere- ------------- .......... <br /> (2) ---M. -IsYN't-------Q-C�-eh---- --------------------5:3-C---t---------- --------kK30- ------- <br /> . .3 --------------M--Q-s-6pee <br /> (3) ---q6—?r t-----cp-qe-p--------------------------1.L-4-------------IN-Mos----I—ct n d �n!i -------------- q-:5 �, <br /> - ------------------ - -------- -er-a <br /> Uses to which net proceeds will be applied: -------5-CVN-Q-t a r S -1 ------6p-(------------C---C-',. <br /> g--- CO --- <br /> --------------S A--Q-3-5tm ------------------------------------------------------------------------------------------------------------------------------ --------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------- ..........cer <br /> ------------------------------- <br /> (signature of authorized officer or member of organization) <br /> Application certified to be in <br /> conformity with C. 810, Acts <br /> of 196 <br /> City/Town Clerk <br /> PERMIT (ISSUED) (DENIED) <br /> aAA 0 <br /> ----- -------- .................. The applicant (is) <br /> ------ .]...LIL� -i�) qualified to operate raffles and <br /> I'date). . . bazaars under the provisions of C. 810, Acts of 1969: <br /> - - <br /> City/Town -------- <br /> Clerk <br /> ------------------- <br /> FORM 810 HOBBS & WARREN, INC. <br />