FORM 1023-EZ for ADRENALINE THERAPY

Field Data
EIN 84-2987485
Case Number EO-2019259-000460
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADRENALINE THERAPY
Organization’s Mailing Address 18705 95TH AVE CT E
City PUYALLUP
State WA
ZIP 98375
Accounting period End 9
Primary contact name JONATHAN WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JON WILLIAMS
FOUNDER / PRESIDENT / TREASURER
18705 95TH AVE CT E
PUYALLUP WA 98375

Officer/Director/Trustee Two

ARIANA COLE
VICE PRESIDENT
18705 95TH AVE CT E
PUYALLUP WA 98375

Officer/Director/Trustee Three

ROBERT HIGHMAN
SECRETARY
18705 95TH AVE CT E
PUYALLUP WA 98375

Organization’s website WWW.ADRENALINETHERAPY.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/5/19
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W30 - Military, Veterans' 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 No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JON WILLIAMS
Signature Title FOUNDER / PRESIDENT / TREASURER
Signature Date 9/10/19

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