FORM 1023-EZ for MOUNTLAKE TERRACE COMMUNITY FOUNDATION

Field Data
EIN 82-1737645
Case Number EO-2017194-000368
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOUNTLAKE TERRACE COMMUNITY FOUNDATION
Organization’s Mailing Address 4606 227TH ST SW
City MOUNTLAKE TERRACE
State WA
ZIP 98043-4420
Accounting period End 12
Primary contact name DOUGLAS HOFFMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DUSTIN DEKOEKKOEK
PRESIDENT
23010 54TH AVE W
MOUNTLAKE TERRACE WA 98043-4706

Officer/Director/Trustee Two

DOUGLAS HOFFMAN
VICE-PRESIDENT
4606 227TH ST SW
MOUNTLAKE TERRACE WA 98043-4420

Officer/Director/Trustee Three

ROBERT PAINE-DONOVAN
SECRETARY
5703 237TH ST SW
MOUNTLAKE TERRACE WA 98043-5122

Officer/Director/Trustee Four

ADAM BETTCHER
TREASURER
5706 224TH ST SW
MOUNTLAKE TERRACE WA 98043-3844

Organization’s website WWW.MLTCF.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/25/2017
Organization Incorporation State WA
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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