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• <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />m gs #PES <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 />&H4begV bis,4ovoey Inas am OF OA&- L'OY�,INC. QLI� L'AP�eo� L�urc L 2EN 5 musEu n <br />,5'1'7 l'46;47- N&e,c .eb So"TH10 mrasgP6r, Mq 10-46tz <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 />Le(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) ,T4��✓L'DrTon/ 310 No�sKA .P.D MAsNPrnA oa��f9 <br />(2) Tllb-MA6 17?dk1A11Ay 3S,QEGL6Crt; tl 16jel VC, �SAnJJSU�rCfF� /hq 100363 <br />(3) 6'407r �/4yno^4 /171LZ-- TDA)e- ST- ND: GAC/nOL(TN rhR oa33L <br />Uses to which net proceeds will be applied: EX Lt14 /TS & 10k66-egms <br />Appnca ;oln certified to a in <br />conform[ with C. 810 Acts <br />of 1969: <br />y/Town C r <br />PERMIT (ISSUED) ii'' <br />FORM 810 Rev. 12/91 H&W HOBBs B WARREN'm <br />(signature of <br />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 />OVER <br />