FORM 1023-EZ for CLUB LOKAHI VOLLEYBALL

Field Data
EIN 47-1645243
Case Number EO-2015299-000343
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLUB LOKAHI VOLLEYBALL
Organization’s Mailing Address PO BOX 1707
City ZILLAH
State WA
ZIP 98953
Accounting period End 8
Primary contact name TRACI ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NICK KOERNER
PRESIDENT
PO BOX 1707
ZILLAH WA 98953

Officer/Director/Trustee Two

ERIN KOERNER
CLUB DIRECTOR
PO BOX 1707
ZILLAH WA 98953

Officer/Director/Trustee Three

TRACI ANDERSON
TREASURER
PO BOX 1542
ZILLAH WA 98953

Officer/Director/Trustee Four

SHERI STILES
SECRETARY
2571 BRANCH RD
WAPATO WA 98951

Organization’s website WWW.ETEAMZCLUBLOKAHI.COM
Organization’s email CLUBLOKAHI@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/2014
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
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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