Town of West Stockbridge
Application for a Raffle or Bazaar
Name of Organization: _____________________________________________________
Street Address: ___________________________________________________________
Mailing Address:__________________________________________________________
Town: _______________________ State: ________________ Zip Code: ___________
Organization Type: _______________________________________________________
[You must fit the criteria for eligibility of a Raffle or Bazaar Permit]
Please list three [3] Officers of the organization who will be responsible for the operation of the Raffle or Bazaar.
Name Title
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Reason for Raffle or Bazaar: ____________________________________________
_____________________________________________________________________
Date of Event: _________________________
Applicant's Signature: ______________________ Date: ____________
Print Name and Title: ______________________
Fee: ________
Approved/Disapproved Approved/Disapproved
_______________________ _______________________ Town Clerk Chief of Police
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