FORM 1023-EZ for KHMER VETERANS INTERNATIONAL

Field Data
EIN 47-5475829
Case Number EO-2016106-000159
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KHMER VETERANS INTERNATIONAL
Organization’s Mailing Address 707 T STREET SE
City TUMWATER
State WA
ZIP 98501
Accounting period End 12
Primary contact name THIAN NON PRESIDENT DIRECTOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

THIAN NON
PRESIDENT DIRECTOR
707 T STREET SE
TUMWATER WA 98501

Officer/Director/Trustee Two

POEUN PHON
VICE PRESIDENT DIRECTOR
1817 178TH STREET COURT EAST
SPANAWAY WA 98387

Officer/Director/Trustee Three

MILTON SOK
SECRETARY DIRECTOR
1845 E HARRISON STREET
TACOMA WA 98404

Officer/Director/Trustee Four

VIBOL OUK
TREASURER DIRECTOR
8428 3RD AVENUE SE
LACEY WA 98513

Officer/Director/Trustee Five

SAEM SOK
DIRECTOR
1778 SOUTH 42ND STREET
TACOMA WA 98418

Organization’s website
Organization’s email KHMERVETERANS.CC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/2/2015
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A23 - Cultural, Ethnic Awareness
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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
Signature Title
Signature Date

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