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(cit or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS Q((4 9 Q=p <br />(C. 810, Acts of 1969) Nj (a te) <br />Name and address of Nonprofit Organization: <br />Expiration Date of Permit:7Z i1 Uuf ( <br />Number of Raffles and Bazaars Held: I C) <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposes Were The Proceeds Used? <br />$ 4,q 60, <br />$ <br />$ <br />cur <br />aC li <br />Names & Addresses of Winners of $25.00 or More: <br />�Se e A i+a Chcd us-� <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report is true and complete. <br />Sferc. &ILoctrdSi CPA 1. Mimad N(nitt II &w ivr Dreacr <br />Rpnnt5Mfl —DID( z. <br />�ccountan[) <br />3. <br />Report Certified to be <br />in Conformity With <br />c <br />C. 888100, Acts of 1969: <br />v it Clerk <br />• <br />Signature of Author' d 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, 12/91 ii&W HOBBs 8 WARREN'" <br />xe MA <br />Oa�4�i <br />