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10/18/2006 09:11 <br />• <br />Nam <br />5087789642 <br />NAUSET INC <br />THE COMMONWEALTH OF MASSACHUSETTS <br />PAGE 02 <br />0&0e6 <br />APPLICATION FOR PERMIT TO CONDUCT RAFFLES AND BAZAARS <br />(C. 810, ACTS OF 1%9) <br />Evidence of Qualification for Permit: <br />Q (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 />O ( Fraternal or fraternal benefit society; or, <br />(d) Educational of 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 not 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 Residence Address <br />Application certified to be in <br />conformity with C. 810, Acts <br />of 1969: <br />Citr/To Clark <br />PERMIT (ISSUED) MERBD) <br />WI 2-noco. The Applicant (is) (is not) qualified to operate raffles and <br />a bazaars under the provisions of C. 810, Acts of 1969: <br />C WTa <br />• C rJ of *oe¢ <br />soaM 610 N¢v. IY/B, <br />OVER <br />3 <br />