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• %h F�sN�EE <br />(city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS A G 9 <br />(C. 810, Acts of 1969) (date) <br />Name <br />� wand address of Nonprofit Organization: d WiL-MOU-'s �1lS�d✓ERy 070-CELt✓r OF CAPE (4!), 4ve, <br />d �� Grp &C &i/, ey-t mu.suoilF J77 61,'&q-r,0VeZk P� Soa7W /hRSNP�2y mA 4a&u-7 <br />Expiration Date of Permit: <br />Number of Raffles and Bazaars Held: 1 <br />Amount of Money Received: $ ��ODd. " <br />Expenses Connected with Raffles Conducted: $ 7M <br />Net Proceeds: <br />For What Purposes Were The Proceeds Used? <br />FDL�CI fF�dl�At; �ieD�-ss �fl-/!7S <br />• <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 is true and complete. <br />1. CA <br />/fir <br />2. r44 <br />(Accountant) <br />Report Certified to be <br />in Conformity With <br />C. 10, Acts of 1 69: . <br />• City/To n C rk <br />&4-� a <br />Signature of Authorized Officer <br />or Member of Organization <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 REv. H&W HOBBSa WARRENIM <br />