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• <br />• <br />Nam, <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />c e �A <br />(city' or town) <br />APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br />(C. 810, ACTS OF 1969) <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 />O�'(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 />(1) <br />(2) <br />(3) <br />AT— V—;A.— A.i.t.00� <br />Uses to which net proceeds will/be applied: 4/j e 0/Y ' ii 'y le o / _ it /zl/ <br />/- <br />FORM 810 REV. 12/9I i & HOBBS A WARREN TN <br />officer or member of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions of C. 810, Acts of 1969: <br />OVER <br />P <br />M <br />Application certified to be in _ <br />confority with C.(810 s <br />of 1969: <br />City/Town 1 <br />PERMIT_(ISSUED (DENTEDr <br />VLVVkl Zoo <br />(date) <br />i <br />• <br />i <br />itY/Town Clerk <br />FORM 810 REV. 12/9I i & HOBBS A WARREN TN <br />officer or member of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaars under the provisions of C. 810, Acts of 1969: <br />OVER <br />P <br />M <br />