FORM 1023-EZ for PRIOR LAKE FALL DANCE CLUB

Field Data
EIN 47-1072550
Case Number EO-2015212-000207
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PRIOR LAKE FALL DANCE CLUB
Organization’s Mailing Address PO BOX 62
City PRIOR LAKE
State MN
ZIP 55372
Accounting period End 12
Primary contact name THERESE PALMER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CRISTI FALKENBERG
COACH
PO BOX 62
PRIOR LAKE MN 55372

Officer/Director/Trustee Two

THERESE PALMER
TREASURER
16986 WILDERNESS TRAIL
PRIOR LAKE MN 55372

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/11/2014
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A62 - Dance
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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