FORM 1023-EZ for CONTACT LENS MUSEUM

Field Data
EIN 37-1916988
Case Number EO-2019304-000381
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONTACT LENS MUSEUM
Organization’s Mailing Address 290 JESSICA DRIVE
City FOREST GROVE
State OR
ZIP 97116
Accounting period End 12
Primary contact name CRAIG NORMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PAT CAROLINE
PRESIDENT
290 JESSICA DR
FOREST GROVE OR 97116

Officer/Director/Trustee Two

CRAIG NORMAN
VICE PRESIDENT
290 JESSICA DRIVE
FOREST GROVE OR 97116

Officer/Director/Trustee Three

JIAH PACK
SECRETARY
290 JESSICA DRIVE
FOREST GROVE OR 97116

Officer/Director/Trustee Four

DONALD EZEKIEL
DIRECTOR
290 JESSICA DRIVE
FOREST GROVE OR 97116

Officer/Director/Trustee Five

JOSEPH BARR
DIRECTOR
290 JESSICA DRIVE
FOREST GROVE OR 97116

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/18/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A54 - History Museums
Organization’s purpose Charitable: No
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 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 JIAH PACK
Signature Title SECRETARY
Signature Date 10/29/19

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