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.7 <br />is <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE �2Q • 0 a <br />(c y 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 />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 />K(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 />Residence Address <br />Vl�ii.T1.r�L4dAu^!iT�nA�%�.f iatL���Gilel�►'•i:a•:�C�+'[��=��•secert'-n:yUses to which net proceeds will be applied <br />Application certified to be in <br />confority with C. 810, Acts <br />69. <br />of 19' <br />ity/Town C r <br />PERMIT (ISSUED) 0%91" <br />ity/Town Clerk' <br />_. <br />FORM 810 Rev, 12191 H&W HOBBSA WARREN To <br />(signature of authorized officer or member of organization) <br />The i <br />bazar <br />&a& <br />OVER <br />