FORM 1023-EZ for LIFE HOUSE FELLOWSHIP

Field Data
EIN 45-4478876
Case Number EO-2015239-000254
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE HOUSE FELLOWSHIP
Organization’s Mailing Address PO BOX 820447
City VANCOUVER
State WA
ZIP 98682
Accounting period End 12
Primary contact name ROD LARSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BARRY REBER
PASTOR
6415 NE 94TH AVE
VANCOUVER WA 98662

Officer/Director/Trustee Two

MELISSA REBER
PASTOR
6415 NE 94TH AVE
VANCOUVER WA 98662

Officer/Director/Trustee Three

ROD LARSON
TREASURER
3211 NE 58TH ST
VANCOUVER WA 98663

Organization’s website
Organization’s email MATHMAN64RL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/31/2008
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 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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