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• /j%s���� JLA <br />(city 1%r town>� <br />ANNUAL REPORT - RAFFLES & BAZAARS T �y % tO/D <br />(C. 810, Acts of 1969) ((rate) <br />Name and address of Nonprofit Organization:�/ <br />L/int.t rL �7iv. /l.ni Pn/. ��5 i�CJ )C /glDO. //r <br />• <br />Expiration Date of Permit: -�lm.11L9,6 <br />a <br />Number of Raffles and Bazaars Held: <br />Amount <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposes Were The Proceeds Used? <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 . �Q 7i�f� <br />2. <br />(Accountant) �/ n <br />Report Certified to be <br />in Conformity With <br />C. 810, Acts of 1969: <br />4 11 P -MA L �E. <br />City/ Wn Clerk <br />Signature of Authorized Officer <br />or Member of Organization <br />14 <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 />FORM 812 Rev. Hi HOans A WARREN rM <br />OVER <br />