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C7 <br />is <br />THE COMMONWEALTH OF MASSACHUSETTS <br />FEE <br />M 46 qeA- <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 />-Fy enAA tb-frx- MiA hn, o, L' hn" <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) Fraternalor fraternal benefit society; or, <br />N (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 />Name Residence Address <br />(3) <br />Uses to which net proceeds will be applied: <br />61APet& go <br />Application certified to be in <br />or <br />conf>ity with 810- cts <br />co for <br />'--/ City/TownT1c,k\J <br />PERMIT (ISSUED) ( <br />FORM 810 Rev. 12/81 H HORn58 WARREN IM <br />or member of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaarsun t revisions of C. 810, Acts of 1969: <br />Chief of Police <br />OVER <br />I <br />FORM 810 Rev. 12/81 H HORn58 WARREN IM <br />or member of organization) <br />The Applicant (is) (is not) qualified to operate raffles and <br />bazaarsun t revisions of C. 810, Acts of 1969: <br />Chief of Police <br />OVER <br />