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• <br />0 <br />FORK 812 IiWOS 1 WARR N INC. <br />a, s' (city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS 41A f-k.$Y I. �44�i3 <br />(C. 810, Acts of 1969) (date) ' <br />Name and address of Nonprofit Organization: <br />tL&�r+11 f, n C L,,, r k 14, <br />Expiration Date of Permit: t I a i, is 3 <br />Number of Raffles and Bazaars Held: <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted <br />Net Proceeds: <br />64 <br />$ /® <br />$ 2.f93. N <br />$ 20 <br />For What Purposes Were The Proceeds Used? <br />Names & Addresses of Winners of $25. 00 or More: <br />(Attach Additional Pages as Necessary) <br />We, the undersigned, do hereby certify hat this report is true and complete <br />1 • <br />2. <br />(Accountant) <br />Report Certified to be <br />in Conformity With <br />• C. 810, Acts of 19%69: <br />City/Town Clerk <br />3. <br />Signature of Authorized Officer <br />or Member of Organization <br />L.« will <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) Revised January 1974 <br />