FORM 1023-EZ for LAKE PEPIN ART DESIGN CENTER

Field Data
EIN 20-8683849
Case Number EO-2016288-000275
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE PEPIN ART DESIGN CENTER
Organization’s Mailing Address N3049 NELSON LANE
City STOCKHOLM
State
ZIP 54769
Accounting period End 12
Primary contact name ANDREA MYKLEBUST
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANDREA MYKLEBUST
PRESIDENT
N3049 NELSON LANE
STOCKHOLM WI 54769

Officer/Director/Trustee Two

JOHN MYKLEBUST
TREASURER
PO BOX 610
STOCKHOLM WI 54769

Officer/Director/Trustee Three

CAROL INDERIEDEN
BOARD MEMBER
W9630 GOATBACK RD
PEPIN WI 54759

Officer/Director/Trustee Four

CATHERINE LATANE
BOARD MEMBER
207 PINE STREET
PEPIN WI 54759

Officer/Director/Trustee Five

AMANDA SCHOLZ
BOARD MEMBER
W10915 E LAKE DRIVE
STOCKHOLM WI 54769

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/20/2005
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural Organizations - Multipurpose
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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