FORM 1023-EZ for DETROIT LAKE FOUNDATION

Field Data
EIN 47-4176740
Case Number EO-2015159-000348
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DETROIT LAKE FOUNDATION
Organization’s Mailing Address PO BOX 468
City DETROIT
State OR
ZIP 97342
Accounting period End 12
Primary contact name DEAN ODONNELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHARI FLANDERS
SECRETARY
PO BOX 438
DETROIT OR 97342

Officer/Director/Trustee Two

DEAN ODONNELL
DIRECTOR
PO BOX A
DETROIT OR 97342

Officer/Director/Trustee Three

MARK MESSMER
DIRECTOR
3377 13TH ST E
SALEM OR 97302

Officer/Director/Trustee Four

KELVIN CAMERON
DIRECTOR
4742 LIBERTY ST R X
SALEM OR 97302

Officer/Director/Trustee Five

TONY HEILBLING
DIRECTOR
1190 NW 3RD AVE
CANBY OR 97013

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/20/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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
Signature Title
Signature Date

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