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• <br />• <br />THE COMMONWEALTH OF MASSACHUSETTS <br />�y 7� FEE oS 6Q Da <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 />�_di�D2E/�nJS.1�.+,x�o✓t�� /'/Jl(.SlZti�'! OF�I�oE�i��/4�rL�/i/�`L/d/�(L.i�/[d�f/�':S/7i/LIcZ/��� <br />.S`7'7 U' N-C./ri /✓C�'�C �� �SG,'l-/'Th YJ9t'ISf/�E� /�9/� O3/a'L9 <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 />�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) [�Ju6rras 5. �/ayTOn/ 5` mi ralJC ST L✓ 121riD�;3"G <br />(2) <br />(3) <br />Uses to which net proceeds will be applied: <br />Application certified to be in <br />�_-- ormity with is <br />of 19 <br />C <br />City/ own erk <br />PERMIT (ISSUED) (DENIED) <br />FORM 810 REV. 12,91 (� 1&W ) H0uns8 WnPREN'" <br />(signature of authorized officer or <br />The Applicant (is) (is <br />bazaars under the In <br />Chief of <br />difieq to operate raffles and <br />of C. 810, Acts of 1969: <br />OVER <br />