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0/-2,7 rq's 4P E <br />(city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS I — l a " L <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <br />Oal'� COA Ca—tQ CorpOt-kro, aruoa. F, 10152 t 3b C[� <br />lerT <br />a <br />Expiration Date of Permit: //.31 I D �q <br />Number of Raffles and Bazaars Held: / D <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposes Were The Proceeds Used? <br />1 c <br />0 �fYlClrn n.S i� IT G*IJI <br />l' IGG�aag 4:t4 <br />Names & Addresses of Winners of $500.00 or More: <br />$ 395o-Dts <br />353-7, SD <br />$ <br />T <br />Av'e, (ASAP }a5 C4 of 4o 1 ` zo 0-0 <br />CttucA,!�, tz is -c 175 Skore 57rc&'ET 313oUaN8:37-,..-,t9 6a53a lDoo. 4n0 <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report is true and complete. <br />05 ff <br />(Accountant) <br />Report Certified to be <br />in Conformity With <br />C 810, Acts of 1969 - <br />City To n CI c <br />,A <br />3. <br />Signature of Au� eded Officer <br />or Member of Organization <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.) <br />OVER <br />FORM 812 Rev. H&W HOBBSB WARREN <br />