FORM 1023-EZ for LAKESHORE LIGHTNING BLUE-LINE CLUB

Field Data
EIN 46-4359963
Case Number EO-2014273-000065
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKESHORE LIGHTNING BLUE-LINE CLUB
Organization’s Mailing Address 7205W WESTCHESTER CT
City MEQUON
State WI
ZIP 53092
Accounting period End 6
Primary contact name SHELLEY BURNS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL QUEOFF
PRESIDENT
1074 CANARY CT
GRAFTON WI 53024

Officer/Director/Trustee Two

BRIAN CONNOLLY
VICE PRESIDENT
11719 N RIVERLAND RD
MEQUON WI 53092

Officer/Director/Trustee Three

SHELLEY BURNS
SECRETARY-TREASURER
7205 W WESTCHESTER CT
MEQUON WI 53092

Organization’s website HTTPS://SITES.GOOGLE.COM/SITE/LIGHTNINGBLC/
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/20/2013
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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