FORM 1023-EZ for CORVALLIS LACROSSE CLUB

Field Data
EIN 81-1480651
Case Number EO-2016302-000357
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CORVALLIS LACROSSE CLUB
Organization’s Mailing Address 3463 NW CREST DRIVE
City CORVALLIS
State OR
ZIP 97330-1810
Accounting period End 12
Primary contact name PETER PETERSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTIE DUDENHOEFER
PRESIDENT
3463 NW CREST DRIVE
CORVALLIS OR 97330-1810

Officer/Director/Trustee Two

KIRK SHIMEALL
SECRETARY
3009 NW GRANT PLACE
CORVALLIS OR 97330-1814

Officer/Director/Trustee Three

PETER PETERSEN
TREASURER
8290 NW STARVIEW DRIVE
CORVALLIS OR 97330-2840

Officer/Director/Trustee Four

VINCE REMCHO
MEMBER AT LARGE
4005 SW BROOKLANE DRIVE
CORVALLIS OR 97333-1474

Officer/Director/Trustee Five

STEFAN SEITER
MEMBER AT LARGE
4025 NW MORGAN PLACE
CORVALLIS OR 97330-1732

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/8/2015
Organization Incorporation State OR
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: Yes
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 Yes
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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