FORM 1023-EZ for KITTITAS NEIGHBORHOOD PANTRY

Field Data
EIN 82-2587220
Case Number EO-2020237-000298
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KITTITAS NEIGHBORHOOD PANTRY
Organization’s Mailing Address PO BOX 1071
City KITTITAS
State WA
ZIP 98934
Accounting period End 12
Primary contact name HOLLY DAWSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HOLLY DAWSON
PRESIDENT
1703 SPARROW KNOLL AVE
ELLENSBURG WA 98926

Officer/Director/Trustee Two

GARY BYE
TREASURER
580 LAVONNE LN
ELLENSBURG WA 98926

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/17/2017
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name GARY BYE
Signature Title TREASURER
Signature Date 8/20/2020
EIN 82-2587220
Case Number EO-2017240-000277
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KITTITAS NEIGHBORHOOD PANTRY
Organization’s Mailing Address POB 842
City KITTITAS
State WA
ZIP 98934
Accounting period End 12
Primary contact name VICKI JO DOUVIER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VICKI JO DOUVIER
DIRECTOR/PRESIDENT
20430 MANASTASH RD
ELLENSBURG WA 98926

Officer/Director/Trustee Two

BASIMA HARMON
DIRECTOR/VICEPRESIDENT
309 KING ST
KITTITAS WA 98934

Officer/Director/Trustee Three

DAVILYNN GIBBS
DIRECTOR/SECRETARY
300 MASON ST
KITTITAS WA 98934

Officer/Director/Trustee Four

DANIEL DOUVIER
DIRECTOR/TREASURER
20430 MANASTASH RD
ELLENSBURG WA 98926

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/17/2017
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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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