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• <br />is <br />r <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />M.4sNPEc <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 />�N c?ieEnlS A/SLfO✓C.�y matsr-&m OF 0)q PECW,dba�APEc4oDCai2291Js inusEtrm <br />? 7G 2E x+r A/FZ-74 46 SouTH M`4SHAEUI lh A as to fl9 <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 />V(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) .XgAJ SawY9T 7 u77Y0 MAoa-36 <br />(2) YAJ C IOA/ 36; NaQseA 2b; m19�HOa3 M/.7Oaloti9 <br />M <br />(3) 111T E-runfG -S-W o b &gel✓SrAgli ' Ab 0 6 GAtmourN, n7 e 0�d4 <br />Uses to which net proceeds will be applied: kk ,,617S PA)Z) PkO4) H /nS <br />Application certified to be in <br />conformity with C. 810, is <br />of 1969 <br />City/Town k <br />PERMIT (ISSUED) (9fiNWB)-- <br />date) <br />City/Town Clerk <br />FORM 810 REV, 12/81 Hi HOBBS&WARREN TN <br />(signature of authorized 'officer or membeP of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the pro ' 'ons of C 10, Acts of 1969: <br />Chief f Police <br />OVER <br />