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0 <br />C J <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />ly7asti12 <��- ia — <br />I (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 />-Jer— <br />1p15 2cr-trd-e_ ---4,v mashpee t/�7.� of . //�o <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 />N (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 <br />(1) rIi/cnael LC4-11paerl &xPc <br />(2)Appnf4ra �y✓Jne.,, Arg,SIC <br />(3) (Jr -1 1" OOd1,c64 (A SJ <br />Uses to which net proceeds will be applied: <br />Application certified to be in <br />conformity with C. 810, A is <br />of 1969: <br />City/Town C1e,k <br />PERMIT (ISSUED) eDV~ <br />(date) <br />• City/Town ler <br />FORM $10 REV. 12/81 H&W HOBBSB WARREN TM <br />Residence Address <br />(signature of authorized officht or member of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions of C. 810, Acts of 1969: <br />hief of Police <br />OVER <br />C�7 <br />Is <br />