FORM 1023-EZ for BLUE HERON BOOSTER CLUB

Field Data
EIN 47-5555286
Case Number EO-2015337-000035
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLUE HERON BOOSTER CLUB
Organization’s Mailing Address 83 SE JEROME STREET
City OAK HARBOR
State WA
ZIP 98277-3770
Accounting period End 8
Primary contact name ALLISON PAUL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ALLISON PAUL
PRESIDENT
3850 TAYLOR ROAD
OAK HARBOR WA 98277

Officer/Director/Trustee Two

ANIL TYSON
VICE-PRESIDENT
2019 SW PUTNAM DRIVE
OAK HARBOR WA 98277

Officer/Director/Trustee Three

KIM MERRILL
SECRETARY
1756 SWANTOWN ROAD
OAK HARBOR WA 98277

Officer/Director/Trustee Four

DAWN BROWN
TREASURER
1405 BLACKBERRY LANE
OAK HARBOR WA 98277

Officer/Director/Trustee Five

MELISSA MCSWAIN
ASSISTANT TREASURER
320 SE BARRINGTON DRIVE
OAK HARBOR WA 98277

Organization’s website WWW.BLUEHERONBOOSTERCLUB.ORG
Organization’s email PRESIDENT@BLUEHERONBOOSTERCLUB.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/20/2015
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O12 - Fund Raising and/or Fund Distribution
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 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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