HomeMy WebLinkAboutAnnual Report Raffles and Bazaars
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(C. 810. Acts of 1969) (date)
ANNUAL REPORT - RAFFLES & BAZAARS ___________________________________
Name and address of Nonprofit Organization:
_______________________________________________________________________________________________
Expiration Date of Permit: _________________________________________________________________________
Number of Raffles and Bazaars Held:
Amount of Money Received: $ ______________________
Expenses Connected with Raffle Conducted: $ ______________________
Net Proceeds: $ ______________________
For What Purposes Were The Proceeds Used?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Names and Addresses of Winners of $250.00 or More:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________ (Attach Additional Pages as Necessary)
We, the undersigned, do hereby certify that this report is true and complete.
1. _________________________________
_________________________________ 2 . _________________________________
(Accountant)
3. _________________________________
Report Certified to be
In Conformity With
C. 810 Acts of 1969: _______________________________________________
Signature of Authorized Officer
or Member of Organization
__________________________________________
City / Town Clerk
RENEWAL PERMIT WILL NOT BE ISSUED TO LICENSEE UNTILL THIS REPORT HAS BEEN COMPLETED AND FILED WITH THE
COMMISSIONER OF PUBLIC SAFETY.
(Permit Holders also holding Beano Licenses, must submit a Copy of this Report to the Massachusetts State Lottery Commission.) Revised January 1974