FORM 1023-EZ for LASSEN-LOOMIS CHAPTER 1914 OF E CLAMPUS VITUS

Field Data
EIN 37-1639365
Case Number EO-2017172-000138
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LASSEN-LOOMIS CHAPTER 1914 OF E CLAMPUS VITUS
Organization’s Mailing Address PO BOX 592
City MANTON
State CA
ZIP 96059-0592
Accounting period End 12
Primary contact name JACK ROSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JACK ROSE
PRESIDENT
5521 MARIGOLD LANE
ANDERSON CA 96007-9664

Officer/Director/Trustee Two

WES BORDEN
TREASURER
2799 JUNE STREET 4
REDDING CA 96002-1032

Officer/Director/Trustee Three

SEAN JUNGKEIT
SECRETARY
PO BOX 203
ROUND MOUNTAIN CA 96084-0203

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/28/2006
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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