FORM 1023-EZ for KITSAP COUNTY DUI IMPACT PANEL

Field Data
EIN 46-2888556
Case Number EO-2015231-000179
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KITSAP COUNTY DUI IMPACT PANEL
Organization’s Mailing Address 11 NE BAJA VISTA DRIVE
City BELFAIRQ
State WA
ZIP 98528
Accounting period End 12
Primary contact name GAYLE ROBBINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RONALD TORREZ
PRESIDENT
11 NE BAJA VISTA DRIVE
BELFAIR WA 98528

Officer/Director/Trustee Two

ALBY MACIAS
VICE-PRESIDENT
2109 SOUNDVIEW AVENUE NE
BREMERTON WA 98310

Officer/Director/Trustee Three

GAYLE ROBBINS
TREASURER
11 NE BAJA VISTA DRIVE
BELFAIR WA 98528

Officer/Director/Trustee Four

FRANCIS MACIAS
SECRETARY
2109 SOUNDVIEW AVENUE NE
BREMERTON WA 98310

Officer/Director/Trustee Five

LAURA WULF
DIRECTOR
3121 NORTH GOVE
TACOMA WA 98407

Organization’s website WWW.DUIIMPACTPANEL.COM
Organization’s email DUIIMPACTPANEL@JUNO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/12/2013
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I23 - Drunk Driving Related
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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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