FORM 1023-EZ for BLACK LIVES MATTER VANCOUVER WA

Field Data
EIN 81-2864806
Case Number EO-2016321-000165
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLACK LIVES MATTER VANCOUVER WA
Organization’s Mailing Address PO BOX 303
City VANCOUVER
State WA
ZIP 98666
Accounting period End 10
Primary contact name CECELIA TOWNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CECELIA TOWNER
DIRECTOR
PO BOX 303
VANCOUVER WA 98666

Officer/Director/Trustee Two

ANGELA ADAMS
DIRECTOR
PO BOX 303
VANCOUVER WA 98666

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/30/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
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
Signature Title
Signature Date

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