FORM 1023-EZ for NORTHERN VALLEY VOLLEYBALL CLUB

Field Data
EIN 45-3564407
Case Number EO-2015208-000333
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTHERN VALLEY VOLLEYBALL CLUB
Organization’s Mailing Address 6290 LARDON RD NE
City SALEM
State OR
ZIP 97305
Accounting period End 9
Primary contact name DUSTIN GREER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MELISSA KOENIG
PRESIDENT
4394 JACKPINE ST NE
SALEM OR 97305

Officer/Director/Trustee Two

DUSTIN GREER
DIRECTOR
430 JEFFERSON ST NE
SALEM OR 97301

Officer/Director/Trustee Three

MELISSA KOENIG
DIRECTOR
4394 JACKPINE ST NE
SALEM OR 97305

Officer/Director/Trustee Four

MELISSA KOENIG
DIRECTOR
4394 JACKPINE ST NE
SALEM OR 97305

Officer/Director/Trustee Five

MELISSA KOENIG
DIRECTOR
4394 JACKPINE ST NE
SALEM OR 97305

Organization’s website NORTHERNVALLEYVOLLEYBALL.COM
Organization’s email NORTHERNVALLEYVOLLEYBALL@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/10/2011
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N70 - Amateur Sports Competitions
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 Yes
Donation of funds Yes
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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