FORM 1023-EZ for PALADIN YOUTH FOOTBALL

Field Data
EIN 47-3991856
Case Number EO-2015142-000443
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PALADIN YOUTH FOOTBALL
Organization’s Mailing Address 11609 CLOVERDALE CT SW
City LAKEWOOD
State WA
ZIP 98499
Accounting period End 12
Primary contact name WAYNE HARSHA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WAYNE HARSHA
DIRECTOR, VICE PRESIDENT, TREASURER
11609 CLOVERDALE CT SW
LAKEWOOD WA 98499

Officer/Director/Trustee Two

DAVID SEMERAD
DIRECTOR, PRESIDENT
1223 BELL HILL PLACE
DUPONT WA 98327

Officer/Director/Trustee Three

THOMAS CLARK
DIRECTOR
1973 NELSON ST
DUPONT WA 98327

Officer/Director/Trustee Four

LAUREN SEMERAD
SECRETARY
1223 BELL HILL PLACE
DUPONT WA 98327

Organization’s website WWW.PALADINYOUTHFOOTBALL.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/3/2015
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N65 - Football Clubs, Leagues
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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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