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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 />• <br />L' <br />Name and address of Nonprofit <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 raternal or fraternal benefit society; or, <br />(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 Residence Address <br />Application certified to be in <br />corNkmiity with C. 810 Acts <br />of 1 <br />City/Tow lerk <br />PERMIT (ISSUED) (plWdU94 <br />Se{�} erv`11ey 11 ?om <br />(date) <br />1 Clerk <br />FORM 810 Rev. 12/81 Hkw HOBBsB WFRREN� <br />The Applicant (is) (is <br />bazaars under the pr <br />cer or member , <br />qualified to operate raffles and <br />cps of C. 810, Acts of 19&9: <br />Chief <br />OVER <br />