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4. <br />J�,e �omrmu�eu�z�i o��2iGa��>,uln�l <br />M usNP E <br />city or towh) <br />ANNUAL REPORT - RAFFLES & BAZAARS <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <br />0—*qc-cod Cj�oygc:( 6� WcyynEn.�lc RO, &x I�j N. Falmt�hlMA <br />w <br />Expiration Date of Permit: 1 %Jer , Rcr1"o 0a55(0 <br />Number of Raffles and Bazaars Held: <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposes Were.The Proceeds Used? <br />CD <br />$ 0 <br />$ �■JODo`0 <br />(�CXpc (Lad CeM& Pa WaIM 0 SnC <br />• Names & Addresses of Winners of $500.00 or More: <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report i true and, complete. <br />1 <br />2. <br />(Accountant) <br />Report Certified to be <br />in Conformity With <br />C. 0, Acts of 1969: <br />+�( � W <br />. 1�n <br />City/Tow Jerk <br />(Y)AN m . <br />Signature of Authorized Officer <br />or Member of Organization <br />10 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 Rcv. H&W HOBBS&WARREN iM <br />