FORM 1023-EZ for WESTERN LAKE SUPERIOR AMATEUR RESPONDERS

Field Data
EIN 85-0961691
Case Number EO-2020132-000215
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WESTERN LAKE SUPERIOR AMATEUR RESPONDERS
Organization’s Mailing Address 1411 101ST AVENUE WEST
City DULUTH
State MN
ZIP 55808
Accounting period End 12
Primary contact name DOUGLAS JAMES NELSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOUGLAS NELSON
PRESIDENT
1411 101ST AVE WEST
DULUTH MN 55808-1618

Officer/Director/Trustee Two

JEFFREY NAST
SECRETARY
490 HAWK HILL ROAD
KNIFE RIVER MN 55609-0073

Officer/Director/Trustee Three

DAVID MILLER
TRUSTEE
4793 ANDERSON ROAD
HERMANTOWN MN 55811

Organization’s website
Organization’s email AA0AW@CHARTERMI.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/29/2020
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M99 - Public Safety, Disaster Preparedness, and Relief N.E.C.
Organization’s purpose Charitable: No
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DOUGLAS NELSON
Signature Title PRESIDENT
Signature Date 5/7/2020

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