FORM 1023-EZ for NORTHWEST DERBY LEAGUE

Field Data
EIN 47-2568836
Case Number EO-2014356-000414
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTHWEST DERBY LEAGUE
Organization’s Mailing Address 8874 CONWHIT LN SW
City PORT ORCHARD
State WA
ZIP 98367
Accounting period End 12
Primary contact name EMILY STONECIPHER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHERON MCKINNIE
SECRETARY
12440 CHICKADEE LN NW APT 102
SILVERDALE WA 98366

Officer/Director/Trustee Two

ANTONIA LOUIE
VICE PRESIDENT
3445 WESTMINSTER DR SE
PORT ORCHARD WA 98366

Officer/Director/Trustee Three

LACY GEE
TREASURER
1135 SW HARPER RD
PORT ORCHARD WA 98367

Officer/Director/Trustee Four

CHRISTINE RASE
BOUT PRODUCTION LEAD
7051 WOODLAWN DRIVE NW
BREMERTON WA 98311

Organization’s website WWW.NORTHWESTDERBYCOMPANY.COM
Organization’s email INFO@NORTHWESTDERBYCOMPANY.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/9/2014
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 Yes
Gaming Activity Yes
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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