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is <br />• <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <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 />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 />❑ (b) Church or religious organization; or, <br />❑ (c) Fraternal or fraternal benefit society; or, <br />P' (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 />Residence Address <br />(1) -PAA-W&J Ntr WLAS 4-I5t5ho-Trmd "Rall , rrW2ft(X-L- 014 <br />(2) Ud6- MOLMh S (edan St . j tga �af�- fi14 <br />(3) <br />Uses to which net proceeds will be applied: <br />i b1'" prT&t-nS ) boozA <br />Application certified to be in <br />confor ity with C. 810, Acts <br />of 1969: <br />i <br />City/To Clerk <br />PERMIT (ISSUED) ,() <br />of C� <br />(date) <br />7 <br />0 City/Town Cle k <br />FORM 810 Rev, 12/91 H&W HooBBB WARREN'" <br />SL <br />authorized 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 />O:n <br />-Chief of Police <br />OVER <br />