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• <br />Nam <br />Evidence of t-uatutcatton ror rermu: <br />THE COMMONWEALTH OF MASSACHUSETTS <br />.FEE <br />city or town) city or town) <br />APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br />(C. 810, ACTS OF 1969) <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�) / <br />(d) Church or religious organization; or, <br />�raternal or fraternal benefit society; or, <br />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 />(1)yuuul IV1KV�)n rLA y\, I c <br />(2) <br />(3) <br />Uses to which net proceeds will be applied: <br />certified to be in <br />of 1969: <br />PER (ISSUED) NIED) <br />QO <br />(date) <br />I�-ic��tlNryee� <br />y/Town Cler <br />FORM 810 REV. 12/91 H&W Ho8888 WARREN TV <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions 9d C. 810, Acts of 1969: <br />OVER <br />