FORM 1023-EZ for PLAYBACK THEATER NORTHWEST

Field Data
EIN 91-1506013
Case Number EO-2020112-000009
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLAYBACK THEATER NORTHWEST
Organization’s Mailing Address 12565 42ND AVE NE
City SEATTLE
State WA
ZIP 98125
Accounting period End 12
Primary contact name HAROLD COSTA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HAROLD COSTA
PRESIDENT
12565
SEATTLE WA 98125-4620

Officer/Director/Trustee Two

ROBIN DAWN CHERRY
VICE PRESIDENT
1636 S MCCLELLAN ST APT 9
SEATTLE WA 98144

Officer/Director/Trustee Three

MIGUEL KHOURY
TREASURER
220015 88TH AVE NE
BOTHELL WA 98011

Officer/Director/Trustee Four

PATRICIA DAVIS
SECRETARY
1401 5TH AVE N APT 601
SEATTLE WA 98109

Organization’s website HTTP://PLAYBACKTHEATERNW.ORG/
Organization’s email PLAYBACKTNW@JUNO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/1991
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A65 - Theater
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name HAROLD COSTA
Signature Title PRESIDENT
Signature Date 4/16/2020
EIN 91-1506013
Case Number EO-2016097-000308
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PLAYBACK THEATER NORTHWEST
Organization’s Mailing Address 12565 42ND AVE NE
City SEATTLE
State WA
ZIP 98125
Accounting period End 12
Primary contact name HAROLD COSTA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

HAROLD COSTA
PRESIDENT
12565 42ND AVE NE
SEATTLE WA 98125

Organization’s website HTTPS://WWW.FACEBOOK.COM/PLAYBACKTHEATERNW/
Organization’s email PLAYBACKTNW@JUNO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/1991
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A65 - Theater
Organization’s purpose Charitable: Yes
Religious: No
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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