FORM 1023-EZ for WAYNESVILLE LACROSSE CLUB

Field Data
EIN 83-2922230
Case Number EO-2019046-000394
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WAYNESVILLE LACROSSE CLUB
Organization’s Mailing Address PO BOX 719
City WAYNESVILLE
State OH
ZIP 45068
Accounting period End 12
Primary contact name ADRIEN LARSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER AYERS
PRESIDENT
300 ADAMSMOOR DRIVE
WAYNESVILLE OH 45068

Officer/Director/Trustee Two

DENISE HARTZELL
VICE PRESIDENT
701 ROBINDALE DRIVE
WAYNESVILLE OH 45068

Officer/Director/Trustee Three

AMANDA JOHNSON
TREASURER
710 MIAMI STREET
WAYNESVILLE OH 45068

Officer/Director/Trustee Four

NICOLE LUNDY
SECRETARY
8391 TWIN CREEK DRIVE
WAYNESVILLE OH 45068

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/11/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 JENNIFER AYERS
Signature Title PRESIDENT
Signature Date 2/13/19

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