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• <br />is <br />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 />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 />xfq (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 />(1) Michael CampbPl I , Rxpc, Di rg-r-t-cir 615 Rte- 130F Mastipee, MA 026451 <br />ue 02-703 <br />MA 026 0 <br />Uses to which net proceeds will be applied: Youth Educational PrnqrAnR-q <br />Application certified to be in <br />co n ' with C. 810, Acts <br />of 1 <br />/Town clerk <br />PERMIT (ISSUED ) <br />a 2005 <br />te) <br />•. City wn Cl k <br />FORM 810 REV, 12/91 HkW HOBS& WARRENT" <br />of authorized drficer or member <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions of C. 810, Acts of 1969: <br />Chi f of Police <br />OVER <br />