FORM 1023-EZ for A PHILIP RANDOLPH INSTITUTE - TACOMA CHAPTER

Field Data
EIN 20-0689669
Case Number EO-2014279-000333
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name A PHILIP RANDOLPH INSTITUTE - TACOMA CHAPTER
Organization’s Mailing Address PO BOX 8913
City TACOMA
State WA
ZIP 98418-0913
Accounting period End 12
Primary contact name PATTY ROSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GROVER JOHNSON III
PRESIDENT
PO BOX 8913
TACOMA WA 98418-0913

Officer/Director/Trustee Two

SHERRILLA BIVENS
VICE PRESIDENT
5206 108TH ST CT SW APT 23
LAKEWOOD WA 98499

Officer/Director/Trustee Three

PATTY ROSE
SECRETARY
3049 S 36TH STREET 201
TACOMA WA 98409-5730

Officer/Director/Trustee Four

VANCE LELLI
TREASURER
3049 S 36TH STREET 201
TACOMA WA 98409-5730

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/2003
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence Yes
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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