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THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />m)Is#PEE <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 />d/1rc.zee)ySi - 1/SPo✓&gY 1)7asatln of PAPE &Ayy d/x� �EC�o�L/�si�deF/vs /ylua�vrn <br />S9'l G,e��T.t/�ce � SOflrli MASH®� MlA a�GfFfi <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 />LAS (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) TO/fiJ&noi✓ 3pN0,6SkP el�, Maq oa&vll <br />(2) AERAC 64iP7'/GL 442 /77.9DE[1n/1 63 6, G"W;V &A 4`9 5,66 <br />(3) mA7-r XEr"" 3a9 DCD ,BAfPn/s LC RD, E r�crn0u774, ^9 aa�3G <br />Uses to which net proceeds will be applied: FX641,617SS 54 Ae,96e417z5 <br />Applicati n certified to a in <br />conformi with C. 810, is <br />of 1969: <br />y/Town <br />PERMIT (ISSUED)II <br />City/Town ler <br />(signature of authorized officer or member of organization) <br />The Applicant (is) (is qualified to operate raffles and <br />bazaars un the p ovisio s of C. 810, Acts of 1969: <br />Chief of Police <br />OVER <br />FORM 810 Rev. 12/91 (iii)HOBBs& WARREN rm <br />