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THE COMMONWEALTH OF MASSACHUSETTS <br />• FEE 20,00 <br />Mashpee <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 />Cape Cod Camp Corp d/b/a Farley Outdoor Education Center <br />615 Route 130, Mashpee, MA 02649 <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 />g (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 />(I)Michael Campbell, Exec_ Director 66 .Tnchtta Baker Rd W Yarmout"A <br />(2) Christine Pouliot, Board Pres. 244 East St, Attleboro, MA <br />(3) Ella Fraser, Treasurer Fraser CT., Barnstable, MA <br />Uses to which net proceeds will be appliecyouth Education Programs <br />Application [fied to be in <br />conforIty i h C. 810, Acts <br />of 1969..�v <br />Clerk <br />PERMIT (ISSUED) <br />'h <br />-A-. <br />(date <br />• City/Yowl CI <br />FORM 810 REV. 12/81 H&W HOBB58 WARREN'M <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions of C. 810, Acts of 1969: <br />�1Aof of Polk <br />9e-� <br />OVER <br />