FORM 1023-EZ for CHAZY LAKE WATERSHED INITIATIVE

Field Data
EIN 47-5413854
Case Number EO-2017088-000284
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHAZY LAKE WATERSHED INITIATIVE
Organization’s Mailing Address PO BOX 34
City WATERFORD
State VA
ZIP 20197
Accounting period End 12
Primary contact name MARK DENICORE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARK DENICORE
INITIAL DIRECTOR
PO BOX 34
WATERFORD VA 20197-0034

Officer/Director/Trustee Two

GARY GERMAIN
INITIAL DIRECTOR
808 WILFRED KING ROAD
ELLENBURG DEPOT NY 12935

Officer/Director/Trustee Three

DON JACKSON
INITIAL DIRECTOR
PO BOX 735
DANNEMORA NY 12929-0735

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/10/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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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