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. Mashpee <br />(city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS,,,, , .JanuarT25; �nnS ' <br />(C. 810,_ Acts of 1969), <br />Name and address of Nonprofit Organization:. <br />Cape Cod 4-H Camp Corporation d/b/a/ 4-H Farley, 615 Route 130, Mashpee <br />MA 02649 <br />Expiration Date of Permit: February, 2, 2005 <br />Number of Raffles and Bazaars Held: 10 <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposes Were The Proceeds Used? <br />$ 4,ans nn <br />$ 3,589.75 <br />$ 1,315.25 <br />Mashpee__. T ac111ty <br />Names & Addresses of Winners of $25.00 or More: <br />oSee attached list_ <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report is true and complete. <br />1 -Mi chael ramphel Ir FXPrutiue ni rector <br />Steve Edwards, CPA <br />Hyannis MA 02601 2. <br />(Accountant) <br />3. <br />Report Certified to be <br />'An Conformity With <br />C Acts of 1969 <br />Signature of Authorizdd . _ .. <br />` - - or Member oP;Organization - - a <br />City/Town Clerk <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 R[v. 12/81 H&W Homs& WARREN <br />