FORM 1023-EZ for POWELL LODGE NO 17 I O O F OF

Field Data
EIN 83-3819515
Case Number EO-2019071-000807
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POWELL LODGE NO 17 I O O F OF
Organization’s Mailing Address 140 NORTH CHEYENNE ST APT 309
City POWELL
State WY
ZIP 82435
Accounting period End 12
Primary contact name FLORENCE LIEBERMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FLORENCE LIEBERMAN
PRESIDENT
321 ROAD 10
POWELL WY 82435

Officer/Director/Trustee Two

WONITA KARST-BRONDISH
VICE PRESIDENT
64 QUEENS BLVD
POWELL WY 52435

Officer/Director/Trustee Three

LARRY YONTS
SECRETARY
140 NORTH CHEYENNE ST APT 309
POWELL WY 82435

Officer/Director/Trustee Four

LARRY YONTS
TREASURER
140 NORTH CHEYENNE ST APT 309
POWELL WY 82435

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/22/19
Organization Incorporation State WY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: No
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 Yes
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 LARRY YONTS
Signature Title TREASURER
Signature Date 3/8/19

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