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��� iDvWa �� � <br />• (city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS <br />(C. 810, Acts of 1969) (date) <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 />Names <br />sed?i <br />Names & Addresses of Winners of $25.00 or More: <br />4E'e'1/1 `/ CC /�© 1i1/ 70:� <br />(NrVa�G[_ __ T•Sr�-¢U/�!J/��� /7 D/. /7`L/G�/i//moi ./i//�Q��OO` <br />Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report is true and complete. <br />01 <br />(Accountant) <br />0 <br />Report Certified to be <br />in Conformity With <br />*lActs969: <br />Y/Town Clerk <br />t nature of Aute ized Officer <br />r Member of Organization <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 State Lottery Commission.) <br />OVER <br />FORM st2 Rev. 12/91 HhW Hoses 6 WARREN' <br />