FORM 1023-EZ for CLAIRE STARK MEMORIAL FUND

Field Data
EIN 83-1873010
Case Number EO-2018257-000492
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLAIRE STARK MEMORIAL FUND
Organization’s Mailing Address 74400 HILL ROAD
City COVELO
State CA
ZIP 95428-9529
Accounting period End 12
Primary contact name RON STARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RON STARK
DIRECTOR/OFFICER
74400 HILL ROAD
COVELO CA 95428-9529

Officer/Director/Trustee Two

ERIN FOLEY
OFFICER
1774 TESSA WAY
PETALUMA CA 94954-6703

Officer/Director/Trustee Three

FERN ETIENNE
OFFICER
4190 CANFIELD ROAD
SEBASTOPOL CA 95472-9216

Officer/Director/Trustee Four

PATRICIA MARTINEZ
OFFICER
9990 CHESTNUT LANE
SEBASTOPOL CA 95472-9216

Officer/Director/Trustee Five

MISTY BLACK
OFFICER
644 SNOW ROAD
SEBASTOPOL CA 95472-9216

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name PATRICIA MARTINEZ
Signature Title OFFICER
Signature Date 9/12/18

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