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• <br />• <br />(city or town) <br />ANNUAL REPORT - RAFFLES & BAZAARS <br />(C. 810, Acts of 1969) <br />(date) <br />Expiration Date of Permit: <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?i <br />�,QOG3/✓�(/1� D� S�A//lC�" �O.sQ 1�,l%/G�:OI%�S' <br />Names & Addresses of Winners of $25.00 or More: <br />Additional Pages as Necessary) <br />We, the undersigned, do hereby certify that this report is true and complete. <br />2. <br />(Accountant) <br />3. <br />Report Certified to be <br />in Conformity With <br />C. 810, Acts of 1969: <br />Signature of Authorized Officer <br />or Member of Organization <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 State Lottery Commission.) <br />OVER <br />FORM a12 Rev. 12/21 H&W HOBBSa WARRSR' <br />