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• <br />C7 <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />MtISH&C- <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 />C2gtGDg,N:S ZISC.4,16pV Ma5akM OF &P6&,b, -rmdb& C�AoEeaD ,�a�r/ 5 /riusFzvyr <br />377 612& -,7z? -7-1;f650& ,e,6 o56U rH o94sNPEw rn q Oa6 1,69 <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 />52" (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) �70h'W dd TTOd a .fib ,_./%1� 0�-7A O�lP�9 <br />(2) gdgUar 6U&'"— ql;�, fhA�Eun/E �/%� �. F4up7 4z 7W //74 odf,-34, <br />(3) 61—OU %J0u4bE&1 7q du2LtY 6Lyi) Al, rPt1noUT/t In,4 DN55-6 <br />Uses to which net proceeds will be applied: —VXHfd6S $ Pi2D6.el4A-5 <br />Application certified to be in <br />confortim . ty with C. 810 Acts <br />of 1969: <br />ity/Tow Clerk <br />&,t <br />(signature of authorized officer or member of organization) <br />PERMIT (ISSUED) 09,9fw <br />The Applicant (is) (is not) qualified toe <br />raffles and <br />(date) bazaars under the provisions of C. 0, cts of 1969: <br />• CitY/Town Cler <br />Chief of—police <br />OVER <br />FORM 810 Rev, 12191 H&W Homs& WARREN TM <br />