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(city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS <br />(C. 810, Acts of 1969) <br />Name and address of Nonprofit Organization: <br />Expiration Date of Permit: � > 9le <br />Number of Raffles and Bazaars Held: <br />Amount of Money Received: <br />Expenses Connected with Raffles Conducted: <br />Net Proceeds: <br />For What Purposes Were The Proceeds Used? <br />r <br />Names & Addresses of Winners of $500.00 or More: <br />S7�..5- �',y .&��� "I1 <br />MN <br />(Attach Additional Pages as Necessary) I <br />We, the undersigned, do hereby certify that this report is true and complete. <br />I.� <br />12 <br />3. <br />Report Certified to be <br />in Conformity With <br />C. 81 ,Acts of 19/69: <br />• �„ 1 /azure of ' o zed Officer <br />uex� er o g <br />or Membanization <br />City/Town Clerk <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 Stale Lottery Commission.) <br />OVER <br />�.�.... n.n .. �.. WIAAI IJnnnno 1AI..nn... TM <br />