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• <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />S4)ee A4 <br />(city or tdwn) <br />APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br />(C. 810, ACTS OF 1969) <br />Name and address of Nonprofit <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 />IA -(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 />(2) aro do / els <br />(3) Ma l�tl Ae4el- <br />Uses to which net proceeds will be <br />i <br />Application certified to be in <br />confmi with C. 810, Acts <br />of 19� <br />CityZ n Clerk <br />PERMIT (ISSUED) ,e(�, <br />Q, 3 (d <br />(da� <br />City/To Cler <br />�s T6S F, S <br />�8 F1n,t ✓ / r �) <br />Residence Address <br />C <br />D <br />FORM 810 REV. 12/91 H HoBBsB WARREN TM <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions of C. 810, Acts of 1969: <br />Chief of olice <br />OVER <br />we1yp <br />3s <br />O,?6 �/8 <br />