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• <br />is <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />Town of Mashpee <br />(city or town) <br />APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br />(C. 810, ACTS OF 1969) <br />Name and address of Nonprofit Organization: <br />Dana-Farber Cancer Institute 44 Binney Street Boston MA 02115 <br />Correspondence should be mailed to Kathryn Counihan 10 Brookline Place West 6th Floor Brookline MA 02445 <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 />El (b) Church or religious organization; or, <br />❑ (c) Fraternal or fraternal benefit society; or, <br />❑ ) Educational or charitable organization; or, <br />❑ (e) Civic or servrce c u r rganlzaaon; or, <br />❑ (f) Club or organization organized andoperated 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 />Residence Address <br />(1) Suzanne Fountain 9 Battery Street Apartment # 4 Boston MA 02109 <br />(2) Robert G. Millar III 64 Central Street, Andover, MA 01810 <br />(3) Katy Counihan 34 White Place, #2, Brookline, MA 02445 <br />Uses to which net proceeds will be applied: Raffle proceeds support Dana-Farber Cancer Institute's_ <br />groundbreaking cancer research and excellent patient care services for children and adults of all ages <br />Application certified to be in <br />conformi�, with C. 810, Actg <br />of 1969: <br />City/Town Clerk <br />(signature of authorized officer or member of <br />The Applicant (is) (is not qualified to operate raffles and <br />bazaars under the prcvfsidps of C. 810, Acts of 1969: <br />• Chief <br />FORM 810 Rev, 12191 H&W HOBBSB WARREN" <br />OVER <br />