FORM 1023-EZ for FRIENDS OF 90BY30

Field Data
EIN 81-5449576
Case Number EO-2017170-000136
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FRIENDS OF 90BY30
Organization’s Mailing Address 600 E 39TH PLACE
City EUGENE
State OR
ZIP 97405
Accounting period End 12
Primary contact name DAVID E ATKIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACY DERVIN
PRESIDENT
600 E 39TH PL
EUGENE OR 97405

Officer/Director/Trustee Two

MARA WILE
TREASURER
1347 DALTON
EUGENE OR 97404

Officer/Director/Trustee Three

JASON PATOINE
SECRETARY
3093 CALLA ST
EUGENE OR 97404

Officer/Director/Trustee Four

LANA BLAIR
VICE-PRESIDENT
PO BOX 41613
EUGENE OR 97404

Officer/Director/Trustee Five

JULIE FISCHER
DIRECTOR
1865 MADISON ST
EUGENE OR 97402

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/26/2017
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I72 - Child Abuse, Prevention of
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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