FORM 1023-EZ for CENTRAL PARK LIONS FOUNDATION

Field Data
EIN 81-2035594
Case Number EO-2017107-000115
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CENTRAL PARK LIONS FOUNDATION
Organization’s Mailing Address 7130 LIONS PARK LANE
City ABERDEEN
State WA
ZIP 98520
Accounting period End 12
Primary contact name BRIEN PATTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAN PETERSON
PRESIDENT
621 GREENACRES LN
ABERDEEN WA 98520

Officer/Director/Trustee Two

BRIEN PATTON
SECRETARY/TREASURER
PO BOX 1041
COSMOPOLIS WA 98537

Officer/Director/Trustee Three

BUTCH JOBST
DIRECTOR
7106 BLAINE RD
ABERDEEN WA 98520

Officer/Director/Trustee Four

NORM ADAMS
DIRECTOR
PO BOX 2108
ABERDEEN WA 98520

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/9/2015
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 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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