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f+ <br />I� <br />ANNUAL REPORT - RAFFLES & BAZAARS 06 4yhW7 <br />(C. 810, Acts of 1969) (date) <br />Name and address of Nonprofit Organization: <br />Expiration Date of Permit: <br />Number of Raffles and Bazaars Held: <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposeess7Were The Proceeds Used? <br />i //ewe to el`)Hers — <br />D//Y /n fie. 4e-,Rl" 7'�:4-11-e. (/ <br />Names & Addresses of Winners of $25.00 or More: <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report is true and complete. <br />2. e, <br />(Accountant) <br />3. <br />Report Certified to be <br />in Conformity With <br />C.0, Acts of 1969: <br />• 1 <br />City/T Clerk <br />t l <br />Signature of Authorized Offiq r <br />or Member of Organizatt <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 />OVER <br />FORM 812 REv, 12/91 H HOBB58 WARREN TN <br />